COLUMBIA LIBRARIES OFFSITE 
 
 HEAL1H SUINU.'. MANlJAHIJ 
 
 HX641 26641 
 RC383. A6 B31 1 890 On aphasia, or loss 
 
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ON 
 
 APHASIA, 
 
 OR 
 
 %oss of Jlpjejecft, 
 
 AND 
 
 The Localisation of the Faculty of Articulate 
 Language. 
 
Digitized by the Internet Archive 
 
 in 2010 with funding from 
 
 Open Knowledge Commons 
 
 http://www.archive.org/details/onaphasiaorlossoOObate 
 
Engraving of the Convex Surface of the Left Hemisphere. 
 
 Shoxving the Disposition and Arrangement of the 
 Cerebral Convolutions. 
 
 From a Cast kindly sent to the Author by his lamented 
 friend, the late professor broca, of paris. 
 
 RR, Fissure of Rolando. 
 
 SS, Fissure of Sylvius. 
 
 1 2, 3, First, second, and third frontal convolutions. 
 
 FF, Transverse frontal convolution. 
 
 PP, Transverse parietal convolution. 
 
 00, Orbital convolutions. 
 
 Ti T2, First and second temporo-sphenoidal convolutions. 
 
 1, Island of Reil (the superior and inferior marginal convolutions 
 
 are represented as being drawn asunder so as to expose it.) 
 
 For further description of this Plate, seepage 16. 
 
ON 
 
 APHASIA, 
 
 OR 
 
 %os$ of gpzzth, 
 
 AND 
 
 The Localisation of the Faculty of Articulate 
 
 Language. 
 
 BY 
 
 FREDERIC BATEMAN, M.D., 
 
 Fellow of Ike Royal College of Physicians. 
 
 Senior Physician to the Norfolk and Norwich Hospital ; 
 
 Corresponding Member of the Academy of Medicine of Paris, and of the 
 
 Psychiatrical Society of St. Petersburg ; 
 
 Hon. Member of the New York Neurological Society ; 
 
 Foreign Associate of the Medico-Psychological Society of Paris ; 
 
 Hon. Physician to the Norwich Asylum; Visiting Physician to the Bethel Hospital , 
 
 Consulting Physician to the Lind Infirmary for Children, 
 
 the Norwich Eye Infirmary, 
 
 and the Eastern Counties Asylum for Idiots. 
 
 SECOND EDITION, GREATLY ENLARGED. 
 
 LONDON : 
 
 J. & A. CHURCHILL; 
 
 JARROLD AND SONS, 3, PATERNOSTER BUILDINGS. 
 

 I 35-- &0Z- 
 
PREFACE. 
 
 Perhaps there is no subject in the whole range of 
 neuro-pathology that has engrossed so large a share 
 of the attention, not only of the medical profession, but 
 of scientific men generally, in all parts of the world, as 
 the Localisation of Speech, and the causes which inter- 
 fere with the outward manifestation of that faculty. 
 
 My first edition, published just twenty years ago, was 
 one of the earliest, if not the very first treatise on 
 Aphasia that appeared in this country ; and the favour- 
 able reception accorded to it both at home and abroad, 
 might justly have encouraged me to issue a second 
 edition long ago. I was deterred, however, from a hasty 
 reproduction of the work, by the great diversity of 
 opinion prevalent upon the points at issue, and I have 
 preferred to wait till the horizon of scientific controversy 
 was somewhat cleared, and the tangled skein of medical 
 psychology partly unravelled. 
 
 In the arrangement of my subject, I have followed 
 very much the plan of the first edition, beginning with a 
 condensed bibliographical sketch of the contributions of 
 British, American, and continental writers. As the 
 literature of aphasia has become so immensely enriched 
 
PREFACE. 
 
 during the last twenty years, it may possibly be thought 
 that a Bibliography was an anachronism ; I have, how- 
 ever, decided to retain that portion of the work, as I have 
 reason to believe that it has been useful to other writers, 
 more especially as many of the cases referred to, are 
 contained in works not easily accessible to the majority 
 of my readers. 
 
 The present edition is not merely a reprint of the old 
 one, with a few casual alterations ; I have endeavoured 
 to bring the work up to the present state of our know- 
 ledge of the subject of which it treats, and I have added 
 so much new matter as to constitute it rather a new 
 work than a revised edition of a former one. Amongst 
 the fresh matter added, I may refer to the chapter on 
 the Jurisprudence of Aphasia, a subject of paramount 
 importance to the medical jurist, and which, as far as I 
 know, has not been treated by any British writer. In 
 the concluding chapter certain collateral subjects, only 
 indirectly connected with the localisation of speech, are 
 considered, such as the Minute Anatomy, the Histology, 
 and the Chemistry of the Brain. 
 
 One word as to the title of the book. As I have 
 treated of all disorders of the expression and of the com- 
 prehension of the signs by which man can express his 
 thought, I might, perhaps, have selected a more compre- 
 hensive term than that which I have adopted ; rather, 
 however, than invent a new word, I prefer to retain the 
 word Aphasia, subject to the above explanation. 
 
 When I first wrote upon this subject twenty years ago, 
 the question of the localisation of cerebral function was 
 
PREFACE. 
 
 in its infancy, and our knowledge of the actual patholo- 
 gical changes occurring in nerve tissue were vague and 
 unsatisfactory. Although an immense stride has been 
 made during the last few years in neuro-pathology, we 
 seem still to be to some extent on the threshold of the 
 inquiry ; and the difference of opinion between the most 
 eminent authorities upon the points in dispute is so great, 
 that much is still to be learnt, before we can speak with 
 anything like mathematical precision, of certain functions 
 of that wonderful piece of mechanism — the human brain. 
 Indeed, when I consider the large amount of research 
 that has been expended upon this subject, and contrast 
 it with the precise knowledge that we possess, I am in- 
 clined to say with Goethe : — 
 
 Sag S^cntge bertfcljfoinbct Icidjt fcem 2Slicfce, 
 Ucr boitoartss j3tcl)t, foie bid nod) ufcrtg fcldbt. 
 
 In the preparation of this treatise, I have been much 
 indebted to the kind co-operation of other labourers in 
 the same department of science, both at home and 
 abroad ; and amongst those to whom my especial 
 acknowledgments are due, I may mention Drs. Gowers, 
 Bastian, and de Watteville of London ; Professors 
 Struthers and Hamilton, of Aberdeen ; Professors Ball 
 of Paris, Goltz of Strassburg, and Benedikt of Vienna. 
 
 FREDERIC BATEMAN. 
 
 Norwich, May, 1890. 
 
CONTENTS. 
 
 CHAPTER I. page 
 
 Definition. Bibliography — Hippocrates ; Sauvages. De- 
 scription of the disposition and arrangement of the cerebral 
 convolutions. Writers of the French school — Bouillaud ; 
 Andral ; Drs. M. and G. Dax ; Professor Broca, his ne plus 
 ultra of pathological topography, summary of his two primitive 
 and typical cases ; classification of Jules Falret ; clinical 
 lectures of Professor Trousseau. The celebrated discussion 
 on the localisation of the faculty of speech, at the Academy 
 of Medicine of Paris ; M. Bouillaud's challenge ; the test case 
 of M. Velpeau ; divers observations from the French press. 
 Ladame's statistics of lesions of speech in connection with 
 tumours of the brain. Description of Professor Charcot's 
 diagram of the mechanism of articulate and written language - 13 
 
 CHAPTER II. 
 
 Bibliography continued. Schrceder van der Kolk — his 
 theory of the connection of speech with the olivary bodies, 
 which he regarded as auxiliary ganglia to the hypoglossus 
 nerve ; his argument from Comparative Anatomy ; a case in 
 support of his views ; testimony of Cruveilhier. German 
 writers — Romberg ; Bergmann ; Hasbach ; Von Benedikt and 
 Braunwart ; Kussmaul - - - - 42 
 
CONTENTS. 
 
 CHAPTER III. 
 
 PAGE 
 
 Bibliography continued. English, Scotch, and Irish writers — 
 discussion at the annual meeting of the British Medical 
 Association at Dublin, in 1867 ; aphasia occurring as a com 
 plication of cerebro-spinal arachnitis. American contributions 
 to the literature of aphasia — S. Jackson, Hun, Bigelow ; Wilbur 
 on defects of speech in idiots ; Austin Flint ; Seguin, his 
 statistics of the parts of the encephalon damaged in 556 cases 
 of aphasia; Hammond, his views on the question of the 
 localisation of speech ; divers communications to the American 
 journals - - - - - -52 
 
 CHAPTER IV. 
 
 Author's own clinical experience — Volumetric analysis of the 
 urine in cerebral disease. Aphasia of the ataxic form occurring 
 as the earliest indication of disease ; curious chain of morbid 
 symptoms, eventually merging into general paralysis ; critical 
 analysis of the clinical history ; autopsy ; question of the 
 testamentary capacity of the patient. Three cases of aphasia 
 in which the autopsy revealed a healthy condition of the frontal 
 convolutions ; importance of examining the condition of the 
 bones of the cranium in aphasia, as illustrated by these cases. 
 Loss of speech with paraplegia ; spinal symptoms. Aphasia as a 
 climacteric symptom. Loss of speech with left hemiplegia ; 
 extensive cardiac disease, frontal convolutions healthy, fibrinous 
 blocks in the spleen. Loss of speech, preceded by numbness 
 of the tongue ; lingual spasm, eventually ending in bulbar 
 paralysis. Case of puerperal aphasia ; lacteal derangement, 
 galactorrhaea from vaso-motor paralysis. 
 
 Intermittent aphasia ; epileptic logoneurosis ; peculiar form 
 of aura ; the epileptogenous zone being always in the neighbour- 
 hood of the cervical sympathetic; complete suspension of 
 articulate language for six weeks, without any motor paralysis, 
 and with the general faculty of language unimpaired ; patient 
 
CONTENTS. 5 
 
 PAGE 
 
 able to communicate with others by writing, and also by 
 dactylology. Good effects of electricity ; critical analysis of 
 the exceptional symptoms manifested by this patient. Inquiry 
 as to what part of the complicated mechanism of speech the 
 psychical condition could be pathogenetically referred. Views 
 of Gowers, Trousseau, Kussmaul, and Ball on similar cases. 
 Spasmodic ischsemia - - - 98 
 
 CHAPTER V. 
 
 Synonyms. Definition of aphasia. What is Speech ? Analy- 
 sis of the faculty of Language — Max Muller ; Kussmaul ; 
 Whitney ; Ross ; Cerise ; Parchappe. Speech is a physico- 
 psychical act ; consists of two distinct elements, one somatic — 
 a movement, the other psychical, the interior speech — the 
 Koyos ; the impressive or ingoing, and the expressive or outgoing 
 functions of language. Articulate Language is a Universal 
 attribute of Man — testimony of Dr. Moffatt, Sir Bartle Frere, 
 and Sir Samuel Baker ; the homo mutus of Lord Monboddo. 
 
 The organs of voice, the accoustics of speech, and the 
 mechanism of articulation ; the larynx a musical instrument of 
 extraordinary perfection ; the tongue not essential to speech. 
 Articulate language must not be confounded with the General 
 faculty of language. On the language of Nature in contra- 
 distinction to acquired or artificial language or Speech — the 
 Natural language of the Voice, of the Physiognomy, and of 
 Gesture; illustrations from Euripides, Cicero, Shakespeare, 
 and Corneille. 
 
 Eulogy of gesture-language by Vossius, who preferred it to 
 articulate speech ; serves as the habitual means of communica- 
 tion with the Cistercian and Carthusian monks ; illustrations 
 of the advantage of this form of language, from Lucian, Gilianus 
 and Macrobius. The transition from natural to artificial 
 language exemplified. Speech an acquired reflex. Kussmaul's 
 comparison of the speech mechanism to a telegraphic apparatus. 149 
 
CONTENTS. 
 
 CHAPTER VI. 
 
 Classification. Discussion at the British Association at 
 Norwich in 1868. Professor Charcot on the passive and active 
 phases of the faculty of language. Dr. Bastian on the auditory, 
 visual, and kinesthetic memories. Varieties — Aphasia may be 
 complete or partial, permanent or intermittent. Is sometimes 
 limited to substances ; sometimes to proper names — Thucy- 
 dides, Pliny, Vauvenargues. Baron Larrey's celebrated case of 
 gun-shot wound. The defect may be limited to a particular 
 language ; on one occasion a knowledge of Greek only was lost. 
 Languages revived during delirium. 
 
 Recurring utterances, stereotyped phrases from " fossilisation " 
 of impressions. May be the sole morbid symptom — Professor 
 Rostan's personal experience ; typical case observed by the 
 author. Heterophasia or Paraphasia — the inability to con- 
 nect word-images with their corresponding conceptions. The 
 Spectator on perversion of speech, with an analysis of the 
 author's first edition. Can thought exist without word-images ? 
 A case of verbal delirium. Agraphia, or loss of the faculty of 
 written language — a defect in the cheiro-kinsesthetic centre ; is 
 not a material but a psychical inability to write. 
 
 On Mirror-writing (Spiegelschrift), or the reversal of the 
 normal position of the letters ; Bovarpofadov mode of writing. 
 Greek Epigraphy — Welsford, Roberts. Paramimia, or the 
 perversion of pantomimic language ; remarkable echo case 
 observed by the author at La Salpetriere — a human parrot : an 
 acoustic reflex. The language of Physiognomy. - - 178 
 
 CHAPTER VII. 
 
 Varieties of aphasia continued. Sensory Aphasia — the im- 
 pressive or centripetal function essentially impaired. The 
 psychology of hearing, and the cerebral operations that follow 
 impressions on the ear. Word-deafness — a purely psychical, 
 
CONTENTS. 7 
 
 PAGE 
 
 and not an auditory defect ; may be confounded with insanity. 
 The perception of musical sounds may be abolished as well as 
 that of articulate language — Grant Allen on Note-deafness. 
 
 On verbal amnesia. The psychology of sight, and the cere- 
 bral operations that follow impressions on the eye. Word- 
 blindness — a psychical and not a visual defect ; illustrations 
 from Charcot and Ross. Pathology of Word-deafness and 
 Word-blindness. The auditory and visual centres in the brain ; 
 experiments on animals by Ferrier, Schafer and Sanger Brown ; 
 their conflicting results. Hemianopsia — Gowers on the higher 
 visual centre ; Chauffard, Pfliiger, Skworzoff, and de Watteville. 
 Intermittent Aphasia — -functional cerebral ischaemia. Automatic 
 utterances under emotion — the interjectional expressions of 
 aphasics. Hysterical mutism — essentially of a dynamic nature ; 
 can be produced artificially by hypnotism. - - 216 
 
 CHAPTER VIII. 
 
 Etiology of Aphasia — May be congenital. Deaf-mutism — 
 Kussmaul's statistics as to sex, locality, &c. ; the dumbness not 
 due to the absence of the faculty of speech, but to its want of 
 development. The loquelar defect in Idiots — Esquirol's classi- 
 fication of idiocy ; Kerlin's statistics ; the aphasia of the idiot 
 not to be confounded with deaf-mutism ; intemperance of the 
 parents as a factor in idiocy ; the tardy development of speech 
 from intra-cranial lesion. Aphasia may be the result of exostosis 
 of the cranial bones ; of thrombus of the cerebral arteries ; of 
 ischsemic softening ; of tumours or abscess in the brain, &c. 
 Huguenin on loss of speech in tuberculous meningitis. 
 Macewen on the Surgery of the Brain. Gowers on irritative 
 inhibition. Traumatic Aphasia caused by direct injury to the 
 brain— Baron Larrey, Simon, &c. ; three cases observed by 
 the author. The role of the sympathetic system in the pro- 
 duction of aphasia by vaso-motor paralysis. Loss of speech 
 may occur as a remote symptom of endopericarditis, of spinal 
 
8 CONTENTS. 
 
 PAGE 
 
 disease, and also as the result of emotional excitement. 
 Neurokinesis. May be caused by atmospheric changes ; by 
 reflex action ; by the bite of venomous snakes ; by the action 
 of certain drugs ; by the excessive use of tobacco ; by simple 
 molecular disturbance of the brain cells. Hephsestic hemi- 
 plegia. Puerperal aphasia — cerebral ischaemia. - - 2 45 
 
 CHAPTER IX. 
 
 Diagnosis — Aphonia; whispering is in reality an articulate 
 language, Labio-glosso-pharyngeal paralysis. The speechless- 
 ness of lunatics. Importance of the quantitative analysis of the 
 urine — ureemic poisoning, renal inadequacy. The Sphygmo- 
 graph and the Ophthalmoscope. Thermometric observation 
 and its value in cerebral pathology ; thermic exploration of 
 the different cranial regions — Broca, Voisin, Lombard, and 
 Maragliani. Auscultation of the parietes of the cranium. 
 
 Prognosis — more favourable in traumatic cases, and when 
 uncomplicated with any paralytic symptom. Professor Bene- 
 dikt's case of tardy development of speech in congenital aphasia. 
 Recovery of speech after suspension of the faculty for twenty 
 years. 
 
 Treatment — must depend upon the cause which produces it. 
 Electricity ; its indiscriminate use to be deprecated ; views of 
 Todd, Marcet, and Radcliffe. Influence of sudden mental 
 shock in rousing the dormant faculty of articulate language — 
 Herodotus, Wiedemeister, Ireland. Trephining in traumatic 
 aphasia ; report of three successful cases at the Royal Academy 
 of Medicine of Ireland. On the re-education of the nervous 
 centres - - - - - -279 
 
 CHAPTER X. 
 
 On the Jurisprudence of x\phasia — -French and German 
 writers on the subject; not hitherto treated by any British 
 author. Loss of Speech may affect both civil and criminal 
 responsibility. The testamentary capacity of aphasics — a 
 
CONTENTS. 9 
 
 PAGE 
 
 speechless Mayor ; the validity of wills made by the deaf and 
 dumb ; probate granted of the will of a deaf and dumb testator, 
 whose wife was also a deaf-mute, and who, with other deaf and 
 dumb witnesses, gave evidence at the trial. Remarkable case 
 
 a testator disposing of a large fortune by means of gesture 
 language ; probate of the will being refused solely on the 
 ground of a slight technical formality. 
 
 On the capacity of speechless persons to manage their 
 affairs generally ; important case submitted to the Medico- 
 Legal Society of Paris. The " interdiction " of the French 
 code. The medico-legal aspect of the author's own cases 
 recorded in this treatise, in which the symptoms were due to 
 injury of the expressive mechanism of speech. Word-blindness 
 and Word-deafness, being disorders of the impressive mechanism 
 of speech, may throw doubts upon testamentary capacity, and 
 the study of this form of Sensory Aphasia is of capital im- 
 portance to the medical jurist. 
 
 Inability to speak will not absolve a person from civil and 
 criminal responsibility, and deaf-mutes are held responsible for 
 their acts ; a marriage in which the bridegroom, bride, and 
 bridesmaids were all deaf-mutes, the ceremony being performed 
 in the deaf and dumb alphabet. A cause decided solely on 
 the evidence of three dumb witnesses. Articulate language is 
 not the only medium of thought and of expression ; — the 
 outward sign may be verbal, vocal, graphic, or mimic. A 
 presidential address delivered entirely in gesture language. 
 Aphasia does not necessarily entail testamentary incompetency, 
 or inability to discharge civil or social functions. - - 300 
 
 CHAPTER XL 
 
 Summary — The Psychology of the ancients ; their crude 
 notions of the functions of the brain ; Hippocrates, Aristotle, 
 Servetus, Lapeyronie, Willis, and Huarte. The different 
 theories as to the seat of speech ; Gall, the pioneer of cerebral 
 
IO CONTENTS. 
 
 PAGE 
 
 localisation ; his system of Phrenology based on the external 
 prominences of the skull — cranioscopy; the value of his re- 
 searches. The connection between Matter and Mind. A 
 faculty should not be confounded with the corporeal organ 
 upon which its external manifestation depends. The various 
 theories of the localisation of the faculty of articulate language 
 considered, and weighed by the evidence contained in the 
 preceding chapters. Dr. Allen Starr on diseases of the Pons. 
 The brain not the sole organ of the mind. 
 
 On Hypnotism — its two stages ; desirability of studying 
 hypnotic phenomena; views of Ballet, Bernheim, and Hack 
 Tuke; the Salpetriere experiments and their bearing on the 
 speech question. The decussation of the optic fibres — Grasset, 
 Michael Foster ; views of Hamilton, Ross, and Gowers as to 
 their ultimate course. Views of non-medical writers as to the 
 seat of speech — H. Spenser, G. J. Romanes. Discussion on 
 cerebral localisation at the Washington Medical Congress. 
 The brain compared to a violin. Brown-Se'quard on Inhibition 
 as a factor in aphasia. - - - 3 X 5 
 
 CHAPTER XII. 
 
 Consideration of certain collateral subjects indirectly con- 
 nected with the Localisation of Speech. The minute Anatomy 
 of the brain. The symmetry of the two hemispheres ; views of 
 Todd and Broca; statistics of Lebon. Craniological studies 
 on the skulls of lunatics. Cerebral asymmetry and its relation 
 to criminality ; the reduplication of the second, frontal convolu- 
 tion said to be common in murderers — a statement supported 
 by Benedikt and Bouchard. 
 
 The science of Criminal Anthropology — its literature ; Enrico 
 Ferri on the factors of crime. Professor Lombroso's descrip- 
 tion of the habitual homicide ; Manouvrier on the presence of 
 the metopic suture ; his researches in the Paris catacombs. 
 Gradenigo on the hearing of criminals ; Osier on criminal 
 automata. On psychical anaesthesia ; the peculiar phraseology 
 
CONTENTS. I i 
 
 of the Criminal Anthropologists. The comparative weight of 
 the two hemispheres — statistics of Boycl, Luys, and others. 
 
 The brain from an anthropological point of view ; weight of 
 the brains of eminent men. Minute structure of the cerebral 
 convolutions. Mierzejewski on the brains of Idiots. Broad- 
 bent's researches on the peculiar structure of the third frontal 
 convolution ; great development of this gyrus said to exist in 
 orators ; description of the brain of Gambetta. The Paris 
 society for mutual autopsy. 
 
 Physiology — -considerations on left handed aphasics ; a left- 
 handed family. Ligature of the left common carotid, and its 
 effect on speech. On dextral pre-eminence ; why is the human 
 race right-handed ? Views of Bichat and Ferrier. Aristotle 
 on the preferential use of the right limbs in animals ; dextral 
 pre-eminence observed in monkeys ; the left-handedness of the 
 ancient Hebrews. Embryology — Gratiolet's theory of the early 
 development of the frontal convolutions, denied by Carl Vogt. 
 
 Comparative Anatomy — Is language the exclusive preroga- 
 tive of man ? Leconte and Waterhouse on the gesture language 
 of the ape tribe. The emotional language of certain animals. 
 The mimicry of the parrot merely an acoustic reflex. Articulate 
 speech furnishes the difference of kind between man and 
 animals which Darwin asserted did not exist. Physiological 
 homologies between the brain of man and that of the ape. 
 Carl Vogt on the comparative development of the third frontal 
 convolution in man and in the ape — why man speaks and the 
 ape does not. The frontal convolutions of the microcephali 
 The island of Reil an important characteristic of the human 
 brain. 
 
 Experimental Pathology — Bouillaud's experiments on the 
 brain of animals. Researches of Hitzig, Ferrier, and Duret. 
 Goltz on the croaking of the frog. On the affinities and 
 differences between the brain of man and that of animals — the 
 bridging convolutions ; the hippocampus minor. 
 
 General Anthropology — The comparative facility of speech 
 
12 CONTENTS. 
 
 PAGE 
 
 in the different races of mankind. Gratiolet's three divisions 
 of the human species. The collection of ancient skulls of the 
 Abbe Frere at Paris. The cranial researches of Barnard Davis, 
 Broca, and Flower. Has the cranial capacity of the population 
 been increasing in proportion to the progress of civilisation ? 
 Latin writers on the progressive deterioration of the human 
 family. The recent controversy on the diminution of the 
 average size of heads, as illustrated by the change in the size 
 of hats. Herodotus on the influence of head coverings on the 
 thickness of the skull ; his description of Persian and Egyptian 
 skulls. Skulls of the Egyptian mummies. Broca's comparison 
 between the heads of twenty-four medical students and the 
 heads of twenty-four ward attendants. Importance of anthro- 
 pology to the student of the science of language. 
 
 What do we understand by the expression "Faculty of 
 Speech ? " Does the loss of this faculty necessarily imply 
 organic lesion of structure ? Richardson's experiments of freez- 
 ing the cerebrum of animals — refrigerated frogs. Experiments 
 on pigeons — the " Potentiality of Vitality." Action of chloro- 
 form on nerve tissue. Each brain cell a minute voltaic battery. 
 Cerebral Thermometry — the temperature within the cranium 
 compared with that of the scalp. Pernicious Anaemia — Bristowe, 
 Leven, and Seppilli on hypoglobulia or diminution of the 
 number of the red blood corpuscles. 
 
 On the Chemistry of the Brain— Thudicum on the phos- 
 phorised principles and the cerebromides. Is the variation in 
 conversational power dependent on the chemical composition 
 of the brain ? The phosphorus theory considered — the supposed 
 connection between the amount of phosphorus in the brain and 
 intellectual vigour; views of Moleschott and Couerbe ; the 
 influence of intellectual activity upon the elimination of phos- 
 phoric acid in the urine. Concluding remarks. 359 
 
APHASIA, 
 
 OR 
 
 %05S 0f Mp&ZCll, 
 
 AND 
 
 The Localisation of the Faculty of Articulate Language. 
 CHAPTER I. 
 
 Definition. Bibliography. Hippocrates ; Sauvages. Description of the 
 disposition and arrangement of the cerebral convolutions. Writers of the 
 French School — Bouillaud ; Andral ; Drs. M. and G. Dax ; Professor 
 Broca, his ne plus ultra of pathological topography, summary of his two 
 primitive and typical cases; Jules Falret ; Trousseau. The celebrated 
 discussion at the Academy of Medicine of Paris ; case of M. Velpeau's 
 barber ; divers observations from the French press. Description of 
 Professor Charcot's diagram of articulate and written Language. 
 
 APHASIA is the term which has recently been given to 
 the loss of the faculty of language, and of the power of 
 giving expression to thought, the organs of phonation 
 and of articulation, as well as the intelligence being 
 unimpaired. The pathology of this affection has been 
 for several years past, and is still, the subject of much 
 discussion in the scientific world ; although only a 
 symptom common to several morbid conditions, it has 
 found a place in all systematic treatises on diseases of 
 the nervous system ; the Academy of Medicine of Paris 
 
 B 
 
14 APHASIA, OR LOSS OF SPEECH. 
 
 devoted several of its seances during the year 1865 to 
 its special elucidation, and the medical journals of 
 our own country, as well as those of France, Germany, 
 and America, have lately contained a good deal of original 
 matter bearing upon this obscure feature in cerebral 
 pathology. 
 
 In a brief communication to the " Lancet " for May 20, 
 1865, I drew attention to the then existing state of our 
 knowledge of the pathology of aphasia, this essay being, 
 I believe, one of the earliest notices of this subject 
 published in this country ; since that period I have had 
 occasion to make researches among various British and 
 foreign authors, and having noticed a certain number of 
 curious observations tending to illustrate the various 
 theories in connection with loss or lesion of the faculty 
 of speech, I have thought it not a useless task to give 
 a resume 'of the labours of scientific observers in various 
 parts of the world, who are endeavouring to elucidate 
 this complex question, adding thereunto the result of 
 my own personal experience, the clinical history of my 
 own cases being given with a considerable amount of 
 minute detail. 
 
 It is my intention in the following treatise to consider 
 the subject from a wider point of view than that adopted 
 by previous writers ; I propose to study the physical 
 and psychical nature of the loss or perversion of language 
 both natural and artificial, and I shall embrace all 
 degrees of impairment of speech, both as regards language 
 itself or its power of expression. I prefer, therefore, to 
 use the word aphasia in its strictly etymological sense — 
 a {frao-io- — and I would thus apply it to all cases where 
 speech is abolished or suppressed for whatsoever cause, 
 believing that is more convenient for the purposes of 
 
HIPPOCRATES ; SAUVAGES. 1 5 
 
 pathological research, thus to consider lesion of speech 
 in its general and widest sense. The various prevalent 
 physiological theories will be discussed, and I shall also 
 enter into the domain of facts, and ask of clinical obser- 
 vation a solution of the difficulties with which my subject 
 is surrounded. 
 
 From time immemorial, loss of speech, unconnected 
 with any other paralytic symptom, must have been 
 noticed, but it is only of late that the diagnostic value of 
 this symptom has been recognised, and its pathology 
 attempted to be explained ; and it is probable, more- 
 over, that early observers may have confounded paralysis 
 of the tongue from disease of the hypoglossus, with that 
 loss of the memory of words, and inability to give 
 expression to the thoughts which characterise aphasia. 
 
 It has been stated that Hippocrates confounded 
 aphasia with aphonia ; I am inclined, however, to think 
 that the reputation of the Father of Medicine has suffered 
 from the fault of his English translator, for in his 
 " Epidemics "* he describes a disease characterised by 
 sore throat and hoarseness of voice, using the phrase 
 
 " iroK\a\ (pdpvyyas eirovrjarav (powai KaKov/J.ei'ai" the last tWO WOl'ds 
 
 of which have been erroneously rendered in English 
 " loss of speech ! " In another place, Hippocrates clearly 
 distinguishes between loss of speech and loss of voice, 
 by employing the words " avavdos" and "a^w" in the 
 description of the same case. 
 
 The following passage from Sauvages shows that the 
 distinction was clearly understood by him: "Aphonia 
 est plenaria vocis suppressio. Mutitas (quibusdam 
 
 * Hippoc. "de Morb. Pop.," lib. iii., sec. ii., p. 80, edit. Innys. 
 
l6 APHASIA, OR LOSS OF SPEECH. 
 
 alalia) est impotentia voces articulatas edendi, seu ser- 
 monem proferendi." 
 
 For the better understanding of the subject, it seems 
 desirable to enter into a few anatomical details, and as 
 the minute anatomy of the surface of the brain has not 
 to my knowledge been so elaborately described by any 
 English author, as by the late Professor Broca, I have 
 condensed the following account from his classical work, 
 " Sur le Siege de la Faculte du Langage Articule." 
 
 The anterior lobe of the brain comprises all that part 
 of the hemisphere situated above the fissure of Sylvius 
 (which separates it from the temporo-sphenoidal lobe), 
 and in front of the furrow of Rolando, which divides it 
 from the parietal lobe. The direction of the furrow of 
 Rolando is nearly transverse ; starting from the inter- 
 hemispheric median fissure, it descends almost in a direct 
 course, but with some slight fiexuosities, terminating 
 below and outside of the fissure of Sylvius, which it 
 meets almost at a right angle, behind the posterior 
 border of the lobe of the insula ; in front this furrow is 
 bounded by the transverse frontal convolution, and 
 behind by the transverse parietal convolution. 
 
 The anterior lobe is composed of two stories or 
 divisions, one inferior or orbital, formed by several con- 
 volutions called orbital, which lie on the roof of the orbit; 
 the other superior, situated beneath the frontal bone, 
 and under the most anterior part of the parietal. This 
 superior division of the anterior lobe is composed of four 
 fundamental convolutions, called the frontal convolutions ; 
 of these, one is posterior, the others are anterior. The 
 posterior, slightly tortuous, forms the anterior boundary 
 of the furrow of Rolando ; it is therefore almost transverse, 
 
DESCRIPTION OF THE CEREBRAL CONVOLUTIONS. I J 
 
 and ascends from without inwards from the fissure of 
 Sylvius to the great median fissure which receives the 
 falx cerebri ; it has been variously described as the 
 posterior, transverse, or ascending convolution. The three 
 other convolutions of the superior division are very 
 tortuous and complicated ; they have all an antero- 
 posterior direction, and running side by side, extend 
 from before backwards over the whole length of the 
 frontal lobe, terminating behind at the transverse frontal, 
 into which convolution they all three enter; they are 
 distinguished by the names of first, second, and third 
 frontal convolutions. The first and second frontal con- 
 volutions call for no special remark, but the precise 
 relations of the third are important. This convolution, 
 by its superior border, is contiguous to the second 
 frontal in its whole length ; in reference to its inferior 
 border, the anterior half is in contact with the most 
 external orbital convolution, whereas the posterior half 
 is free, and forms the superior border of the fissure of 
 Sylvius, which separates it from the temporo-sphenoidal 
 lobe. In consequence of this latter relation, the third 
 frontal is sometimes called the superior marginal con- 
 volittion, the name of inferior marginal being given to 
 the superior convolution of the temporo-sphenoidal lobe, 
 which forms the inferior border of the fissure of 
 Sylvius. 
 
 In drawing asunder these two marginal convolutions 
 which bound the fissure of Sylvius, the lobe of the 
 insula is exposed, which covers the extra-ventricular 
 nucleus of the corpus striatum. The result of these 
 relations is that a lesion which is propagated from the 
 frontal to the temporo-sphenoidal lobe, or vice versa, 
 will pass almost necessarily by the lobe of the insula, 
 
1 8 APHASIA, OR LOSS OF SPEECH. 
 
 and from thence, in all probability, it will extend to the 
 extra-ventricular nucleus of the corpus striatum, seeing 
 that the proper substance of the insula which separates 
 the nucleus from the surface of the brain is composed 
 of only a very thin layer.* 
 
 As this subject has more particularly engaged the 
 attention of French pathologists during the last few 
 years, it is most convenient to consider first their re- 
 searches, as the early literature of the localisation of 
 speech is especially associated with the names of 
 Bouillaud, Dax, and Broca. 
 
 As far back as 1825, Bouillaud placed the faculty of 
 articulation in the frontal lobes of the brain, which he 
 considered to be the organs of the formation of words 
 and of memory ; and he stated that the exercise of 
 thought demanded the integrity of these lobes ; he also 
 collected 1 14 observations of disease of the anterior 
 lobes accompanied by lesion of the faculty of speech. 
 
 Audral, who has investigated the subject very fully, 
 analysed 37 cases, observed by himself and others, of 
 lesion of one or both of the anterior lobes, and found 
 that speech was abolished 21 times, and retained 16 
 times ; when the lesion was unilateral, however, he has 
 not stated on which side the morbid condition existed. 
 He has also collected 14 cases where speech was 
 abolished without any alteration in the anterior lobes, 
 but where the lesion existed in the middle or in the 
 posterior lobes. He cites the case of a woman, eighty 
 years of age, who, three years before entering the 
 hospital, was suddenly deprived of speech, without 
 
 * Vide Plate facing title page. 
 
FRENCH WRITERS. 19 
 
 lesion of the intelligence, motion, or sensation, and who 
 still retained the power of walking about ; she presented, 
 however, signs of organic disease of the heart, and died 
 at last of pulmonary apoplexy. At the necropsy, there 
 was found in the left hemisphere, softening of cerebral 
 substance on a level with, and external to, the posterior 
 extremity of the corpus striatum ; and in the right 
 hemisphere, a similar softening at the junction of the 
 anterior and posterior half of the hemisphere.* 
 
 Then comes Dr. Dax, who places the lesion exclusively 
 in the left hemisphere, basing his theory on the fact 
 that when the subjects of aphasia are at the same time 
 hemiplegic, the paralysis is always on the right side, his 
 essay containing no less than 140 observations in support 
 of his views. 
 
 His son, Dr. G. Dax, following in the wake of his 
 father, wrote an essay, in which, whilst confirming the 
 theory as to the lesion being in the left hemisphere, he 
 localised it more especially in the anterior and external 
 part of the middle lobe. 
 
 The ne plus ultra of pathological topography, how- 
 ever, was reserved to M. Broca, who originally defined 
 the seat of lesion in aphasia to be " the posterior part of 
 the third frontal convolution of the left hemisphere ! " He, 
 however, subsequently extended his area to the island 
 of Reil, and to the extra-ventricular nucleus of the corpus 
 striatum, and affirmed that as soon as a lesion occurs 
 in the immediate neighbourhood of the left island of 
 Reil, and especially in the convolutions directly above 
 it, aphasia is the invariable result. M. Broca's views are 
 detailed at some length in the proceedings of the Paris 
 
 * " Clinique Medicale, " chap, iv., observ. xvii. 
 
20 APHASIA, OR LOSS OF SPEECH. 
 
 Anatomical Society for 1861, and the following is a brief 
 summary of the two cases upon which he founded his 
 somewhat startling theory. 
 
 A man named Leborgne, 50 years of age, and epileptic, 
 was admitted into the surgical ward of M. Broca, at 
 Bicetre, for phlegmonous erysipelas, occupying the 
 whole of the right lower limb. When M. Broca 
 questioned him about the origin of his disorder, he only 
 answered by the monosyllable " Tan," repeated twice, 
 and accompanied by a gesture of the left hand. On 
 making inquiries, it transpired that this man had been 
 an inmate of the hospital in another wing for twenty- 
 one years ; that he had been the subject of epilepsy 
 since infancy ; that he had followed the occupation of a 
 lastmaker up to the age of thirty, when he lost his 
 speech, but no information could be elicited as to 
 whether the loss of speech had come on suddenly, or 
 had been ushered in by any other symptom. 
 
 On his admission at Bicetre, he is stated to have been 
 intelligent, understanding all that was said to him, and 
 differing from a perfectly healthly man only in the loss 
 of the faculty of articulate language, for whatever ques- 
 tion was put to him, he invariably answered by the 
 monosyllable " Tan," which, with the exception of a 
 coarse oath (" S — 11 — de D — "), composed his voca- 
 bulary. At the end of ten years, a new symptom showed 
 itself in weakness in the motor power of the right arm, 
 which gradually resulted in complete paralysis of the 
 right side, and he had already been bedridden seven 
 years, when the occurrence of a surgical complication 
 rendered it necessary to transfer him to the ward of 
 M. Broca, who, in describing his the?i condition, states that 
 
PROFESSOR BROCA'S TWO PRIMITIVE CASES. 21 
 
 there was no distortion of the face, the tongue was pro- 
 truded straight, the movements of that organ being 
 perfectly free in every direction; mastication was unim- 
 paired, but deglutition was effected with some difficulty, 
 this being, however, due to commencing paralysis of the 
 pharynx, and not to paralysis of the tongue, for it was 
 only the third period of deglutition which was difficult ; 
 the voice was natural, and the functions of the bladder 
 and rectum were unimpaired. 
 
 The patient having died in six days, a careful post- 
 mortem examination was made, when all the viscera 
 were found healthy, with the exception of the encephalon ; 
 the muscles of the right upper and lower extremities, 
 however, were in an advanced stage of fatty degenera- 
 tion and shrivelled up. The bones of the cranium were 
 somewhat increased in density, the dura mater thickened 
 and very vascular, the pia mater considerably injected 
 in certain places, and everywhere thickened, opaque, and 
 infiltrated with yellowish plastic matter of the colour of 
 pus, but which, examined under the microscope, did not 
 contain any pus-globules. The greater part of the 
 frontal lobe of the left hemisphere was softened, and the 
 destruction of cerebral substance had resulted in a cavity 
 of the size of a hen's egg and filled with serum ; the 
 cavity was situated upon a level with the fissure of 
 Sylvius, and was caused by the destruction of the inferior 
 marginal convolution of the temporo-sphenoidal lobe, 
 of the convolutions of the island of Reil, and of the 
 subjacent part or extra-ventricular nucleus of the corpus 
 striatum. In the frontal lobe, the inferior part of the 
 transverse frontal convolution was destroyed, as also the 
 posterior half of the second and third frontal convohitions, 
 the loss of substance being most apparent, however, in 
 
22 APHASIA, OR LOSS OF SPEECH. 
 
 the third frontal convolution. The weight of the 
 encephalon after the evacuation of the fluid filling the 
 cavity, did not exceed 987 grammes (35 ounces), being 
 less by 400 grammes (14 ounces) than the average 
 weight of the brain in men of fifty years of age. 
 
 M. Broca then compares the result of the autopsy with 
 the clinical observations during life ; he considers that 
 the primary seat of mischief was probably in the third 
 frontal convolution, extending gradually to the others, 
 and that this process of disorganisation corresponded to 
 the first stage of the clinical history, which lasted ten 
 years, and during which period the faculty of speech 
 alone was abolished, all the other functions of the body 
 being intact ; the second stage, which lasted eleven years, 
 and which was characterised clinically by partial paralysis, 
 and then complete hemiplegia, he connects with the 
 extension of the disease to the island of Reil and to the 
 extra-ventricular nucleus of the corpus striatum. 
 
 The above case effectually converted M. Broca to the 
 doctrine of localisation, and was the starting-point to all 
 his subsequent brilliant researches in reference to the 
 seat of articulate language. 
 
 A man, aged 84, formerly a sailor, was admitted 
 into the surgical ward at Bicetre on the 27th October, 
 1 86 1, for a fracture of the neck of the femur. This man 
 had been received into the hospital eight years before 
 for senile debility, there being at that time no paralysis, 
 and the organs of special sense and the intelligence being 
 unimpaired. In the month of April, i860, whilst des- 
 cending a staircase he fell, suddenly became unconscious, 
 and was treated for what was considered to be an attack 
 of apoplexy ; in a few days he was convalescent, there 
 
PROFESSOR BROCA'S TWO PRIMITIVE CASES. 23 
 
 never having been the least symptom of paralysis of 
 limbs, but since the fit he had suddenly and definitely 
 lost the faculty of speech, being only able to pronounce 
 certain words articulated with difficulty ; his intelligence 
 had received no appreciable shock ; he understood all 
 that was said to him, and his brief vocabulary, accom- 
 panied by an expressive mimic, enabled him to be 
 understood by those who lived habitually with him. 
 He continued in this condition up to the time of the 
 accident which caused him to be transferred to the 
 surgical ward under the care of M. Broca, to whose 
 questions he only answered by signs, accompanied by 
 one or two syllables pronounced hastily and with visible 
 effort. These syllables had a definite meaning, and 
 consisted of the following French words — "out, 11011, tois 
 (for trois), and toujours!' He also possessed a fifth word, 
 which he only pronounced when he was asked his name, 
 he then answered " Lelo," for Lelong, which was his 
 proper name. The three first words of his vocabulary 
 corresponded each to a definite idea. When he wished 
 to. affirm or approve he said "out," employing the word 
 "non" to express the opposite idea. The word " tois " 
 expressed all his ideas of numbers, but as he was aware 
 it did not correctly convey his thoughts, he rectified the 
 error by gesture; for instance, when asked how long he 
 had been at Bicetre, he answered tois, but raised eight 
 fingers. When asked what was o'clock (it being then 
 ten) he answered tois, and raised ten fingers. Whenever 
 the three other words were not applicable, he invariably 
 used the word toujours, which consequently for him had 
 no definite meaning. There was no paralysis of the 
 tongue, which was protruded straight, and was movable 
 in every direction, each half being of the same thickness ; 
 
24 APHASIA, OR LOSS OF SPEECH. 
 
 sight and hearing were good, deglutition was normal, 
 and there was no paralysis of the limbs, nor of the rectum 
 or bladder. 
 
 M. Broca sums up the symptoms by calling attention 
 to the following salient points: 1st, that the patient 
 understood all that was said ; 2nd, that he applied with 
 discretion the four words of his vocabulary ; 3rd, that 
 his intelligence was unimpaired ; 4th, that he understood 
 numbers; 5th, that he had neither lost the general 
 faculty of language nor the movement of the muscles 
 concerned in phonation and articulation ; and that there- 
 fore he had only lost the faculty of articulate language. 
 The patient died in twelve days. Autopsy. — The bones 
 of the cranium were somewhat thickened, and all the 
 sutures ossified ; the dura mater was healthy ; the arach- 
 noid cavity contained a considerable quantity of serum ; 
 the pia mater was neither thickened nor congested. The 
 encephalon weighed, with its membranes, 1 1 36 grammes 
 (40 ounces), being far below the average weight of that 
 of adult males. The right hemisphere, the cerebellum, 
 the pons varolii, and the medulla oblongata were in a 
 perfectly normal condition. In the left hemisphere, the 
 lesion was limited to a loss of substance, very accurately 
 defined, in the posterior third of the second and third 
 frontal convolutions, a small cavity having been thus 
 formed which was filled with serum. The walls of the 
 cavity and the neighbouring cerebral tissue were firmer 
 than usual ; there were present some little spots of an 
 orange-yellow colour, apparently of an haematic origin, 
 and microscopic examination revealed the presence of 
 blood crystals. The lesion then was clearly not soften- 
 ing, but the seat of a former apoplectic clot ; and it 
 will be remembered that the patient suddenly lost his 
 
DR. FALRETS CLASSIFICATION. 2$ 
 
 speech in an attack of apoplexy eighteen months before 
 his death. 
 
 In alluding to the above two cases, M. Broca says that 
 in the first case — that of Leborgne — it is only by com- 
 paring the different stages of the disease as observed 
 during life with the post-mortem appearances, that he 
 assumes the high probability of the lesion having com- 
 menced in the third frontal convolution ; but in the 
 second case — that of Lelong — there being no other 
 symptom than loss of speech, and the lesion being strictly 
 limited to the second and third frontal convolutions, he 
 considers the aphasia was incontestably due to disease 
 of that portion of the nervous centres. Whilst admitting 
 that two cases are insufficient to resolve one of the most 
 obscure and disputed questions in cerebral pathology, 
 M. Broca considers himself justified in asserting that the 
 integrity of the third frontal convolution (and perhaps of 
 the second) appears indispensable to the exercise of the 
 faculty of articulate language.* 
 
 A later writer of the French School, Dr. J. Falret, has 
 collected from various authors no less than sixty-two 
 cases, in the arrangement of which he adopts the follow- 
 ing classification: 1st — All those cases in which the 
 patients, whilst retaining intelligence and integrity of 
 the organs of phonation, can only remember or articulate 
 spontaneously certain words or classes of words, or even 
 certain syllables or letters, but who can repeat and write 
 any word that may be suggested to them by others. 
 2nd — Those in which the patients are only able to pro- 
 nounce spontaneously certain words, syllables, or phrases 
 
 * " Sur le Siege de la Faculte du Langage Articule," p. 39. 
 
26 APHASIA, OR LOSS OF SPEECH. 
 
 always the same, not being, however, able to repeat other 
 words dictated to them, although they retain the power 
 of writing them ; or if the power of repeating words thus 
 dictated be retained, that of writing them is abolished. 
 3rd — Those more rare cases in which the patients can 
 only pronounce certain words always the same, which, 
 aided by gesture, enable them to express their thoughts, 
 the power of reading, writing, and repeating words 
 dictated, being abolished. Dr. Falret admits that this 
 classification is artificial, and probably does not embrace 
 all the varieties met with in practice. After paying a 
 just tribute to recent workers in this field of observation, 
 he concludes his very elaborate essay with remarking : — 
 " That the question of perverted speech and of loss of 
 the memory of words in cerebral affections is not yet 
 matured ; that it is more complex and more extensive 
 than at first sight appears ; that it borders upon the most 
 obscure and the most disputed points of cerebral 
 pathology and of the physiology of language ; and that 
 fresh observations of a detailed character are indis- 
 pensably necessary, and that all generalisation and all 
 absolute conclusions are for the present premature."* 
 
 Professor Trousseau has made this subject a prominent 
 feature in his clinical lectures at the H6tel Dieu, where 
 he details several most interesting cases in which, when 
 hemiplegia existed, it was with one exception always on 
 the right side.f 
 
 During several months of the session of 1865, the 
 Academy of Medicine of Paris became the arena for 
 discussion upon this most interesting subject, in which 
 
 * Des Troubles du Langage, p. 53. 
 
 t " Clinique Medicale," torn, ii., p. 571. 
 
DEBATE AT THE ACADEMY OE MEDICINE OF PARIS. 27 
 
 many of the leading physicians and surgeons took a 
 part. At one of these meetings, M. Trousseau gave the 
 result of his statistical researches, and stated that in 
 134 observations collected by himself, 124 were con- 
 firmatory of M. Dax's proposition of localising the 
 faculty of speech in the left hemisphere, and 10 were 
 contrary. With regard to M. Broca's theory of attribu- 
 ting aphasia to a lesion of the third frontal convolution, 
 he found that 14 cases were in favour of it, and 18 
 opposed to it ; amongst the latter, he mentioned the 
 case of a woman treated at La Salpetriere by M. Charcot 
 for right hemiplegia with aphasia, and where after death 
 there was found a lesion of the left insula, and also of 
 the third frontal convolution of the right side. 
 
 M. Trousseau also cited a case observed by M. Peter, 
 the subject of which was a woman who had left hemi- 
 plegia, and who could only say," Out, parbleu /" who 
 died from the effects of senile gangrene, and at whose 
 autopsy a lesion was found of the third frontal convolu- 
 tion of the right side, also of the insula and of the 
 posterior part of the corpus striatum, there being also 
 embolism of the middle cerebral artery. Here, says 
 M. Trousseau, are two cases of aphasia, with a lesion on 
 the right side. 
 
 At another of these discussions, M. Velpeau alluded 
 to the fact of M. Bouillaud having offered many years 
 since, a prize of 500 francs for any well-authenticated 
 case in which the two anterior lobes were destroyed, or 
 more or less seriously injured, without speech being 
 affected, saying that he (M. Velpeau) should claim the 
 prize on the faith of the following case, with specimen, 
 which he had presented to the Academy twenty-two 
 years before. 
 
28 APHASIA, OR LOSS OF SPEECH. 
 
 In the month of March, 1843, a barber, sixty years 
 of age, came under M. Velpeau's care for a disease of 
 the urinary passages. With the exception of his prostatic 
 disease, he seemed to be in excellent health, was very 
 lively, cheerful, full of repartee, and evidently in possession 
 of all his faculties ; one remarkable symptom in his 
 case being his intolerable loquacity. A greater chatterer 
 never existed ; and on more than one occasion com- 
 plaints were made by the other patients of their talkative 
 neighbour, who allowed them rest neither night nor day. 
 A few days after admission this man died suddenly, and 
 a careful autopsy was made, with the following results: — 
 Hypertrophy of the prostate, with disease of the 
 bladder. On opening the cranium, a scirrhous tumour 
 was found, which had taken the place of the two anterior 
 lobes! Here then was a man who, up to the time of his 
 death, presented no symptom whatever of cerebral 
 disease, and who, far from having any lesion of the 
 faculty of speech, was unusually loquacious, and who 
 for a long period prior to his decease must have had a 
 most grave disease of the brain, which had destroyed a 
 great part of the anterior lobes. 
 
 During the protracted debates at the Academy of 
 Medicine, the pathological and psychological aspects 
 of the question were reviewed with great force and 
 eloquence, and science was enriched with a number of 
 new facts, but the discussion closed without this learned 
 body having arrived at any definite decision in reference 
 to the localisation of the faculty of speech. 
 
 Several very interesting observations have been re- 
 corded in the French press, most of which are more or 
 less corroborative of Broca's views, or at least of the 
 
FRENCH WRITERS. 29 
 
 association of loss of speech with lesion of the left 
 hemisphere. 
 
 In the "Gazette des Hopitaux" for July 1st, 1865, 
 Dr. Lesur mentions a remarkable case of a child who, 
 in consequence of a fracture of the frontal bone caused 
 by a kick from a horse, was trepanned about one inch 
 and a quarter above the left orbit. The child recovered, 
 but during the progress of the treatment, it was observed 
 that pressure on the brain at the exposed part suspended 
 the power of speech, which returned as soon as the 
 pressure was removed. 
 
 Another case of traumatic aphasia has recently 
 occurred in the practice of Dr. Castagnon, the subject 
 of it being a young girl, aged 20, who was shot in the 
 head, the accident resulting in a comminuted fracture 
 of the antero-superior portion of the left parietal ; al- 
 though there was no depression of bone, several spiculae 
 were removed, and there was subsequently hernia 
 cerebri and sphacelus of the protruded portion, which 
 was removed by ligature. There was a comatose con- 
 dition for six days, dextral paralysis and complete loss 
 of speech for a month, at the end of which time she 
 could speak, her vocabulary, however, being limited to 
 four phrases, " Jllon Dieu! Jesus! mon pere, ma mere? 
 At the expiration of a year, the paralysis had subsided 
 and the patient resumed her occupation, but although 
 the intelligence was as perfect as before the accident, 
 the young girl spoke but very little, and with great 
 difficulty.* 
 
 An interesting case was observed at the Hospital 
 St. Antoine by M. Jaccoud, the subject being a man 
 
 * " Gazette des Hopitaux," October 12, 1867. 
 
30 APHASIA, OR LOSS OF SPEECH. 
 
 aged 44, suffering from Bright's disease, who, without 
 any premonitory symptom, suddenly became aphasic, 
 there being no other paralytic symptom except a limited 
 facial paralysis. The aphasia was of short duration, 
 and at the end of five weeks he spoke nearly as well as 
 before, but soon sank from disease of the kidneys. At 
 the post-mortem examination, there was observed fatty 
 degeneration of both kidneys ; insufficiency of the mitral 
 valve, which was covered with small vegetations ; the 
 arteries of the circle of Willis were healthy, and there 
 was no disease of the grey matter of the convolutions, 
 but there was a limited and well-defined softening of the 
 white substance in the immediate neighbourhood of the 
 third frontal convolution of the left anterior lobe, great 
 stress being laid on the fact that the convolution itself 
 was in nowise affected.* 
 
 Professor Behier, in one of his clinical lectures de- 
 livered at the Hotel Dieu, mentioned the case of a 
 woman who was admitted into one of his wards with 
 right hemiplegia, the result of cerebral haemorrhage, 
 and in whom, one of the first symptoms following the 
 effusion was aphasia, which assumed in her case a very 
 exceptional form. This woman was born in Italy, and 
 had resided both in Spain and in France ; of the three 
 languages she had thus acquired, she had completely 
 forgotten Italian and Spanish, and had only retained 
 a most limited use of French, in which language she 
 only repeated as an echo the words pronounced in her 
 presence, without, however, attaching any meaning to 
 them. 
 
 In reference to the question of localisation, M. Behier 
 
 * "Gazette des Hopitaux," May 16, 1867. 
 
FRENCH WRITERS. 3 I 
 
 stated, that after analysing the cases observed during 
 the last few years, as well as those recorded by Aber- 
 crombie, Rochoux, Lallemand, and Andral, he had 
 collected 122 observations opposed to the theories of 
 MM. Bouillaud, Dax, and Broca ; in 82 instances, lesion 
 of the anterior lobes had been observed without aphasia, 
 and in 34 cases, aphasia coincided with disease in other 
 parts of the brain.* 
 
 The next three cases I have to mention are instances 
 of lesion of the third frontal convolution without 
 aphasia ; but as the lesion was on the right side, they 
 may be adduced as negative proofs of the truth of 
 M. Broca's theory. 
 
 M. Fernet has recorded a case of left hemiplegia with- 
 out aphasia in a female aged 36, and at whose autopsy 
 the entire frontal lobe of the right hemisphere was broken 
 down by softening. In the "Gazette Hebdomadaire" 
 for July, 1S63, M. Parrot relates a case of complete 
 atrophy of the island of Reil, and of the third frontal 
 convolution on the right side, with preservation of the 
 intelligence and of the faculty of articulate language. 
 M. Charcot' has recorded the case of a woman, yy years 
 of age, who had left hemiplegia without embarrassment 
 of speech or loss of the memory of words, and at whose 
 autopsy there was found yellow softening of the surface 
 of the right frontal lobe, the second and third frontal 
 convolutions being completely destroyed, and there 
 being no lesion of the central parts of the brain. 
 
 I need scarcely remark that cases like the three just 
 mentioned, of lesion of the right side without aphasia, are 
 
 * "Gazette des Hopitaux," March 20th, 1S69. 
 
32 APHASIA, OR LOSS OF SPEECH. 
 
 quite as valuable in a statistical point of view, and tend 
 as much to settle the qucestio vexata, as cases where the 
 converse condition exists, viz., lesion on the left side 
 with aphasia. 
 
 I now arrive at a class of cases which have a directly- 
 opposite pathological signification to those above men- 
 tioned, the eight following observations being all calculated 
 to invalidate the recent theories as to the seat of articu- 
 late language. 
 
 M. Peter relates the case of a man who fractured his 
 skull by a fall from a horse. After recovery from the 
 initial stupor, there succeeded a remarkable loquacity, 
 although after death it was found that the two frontal 
 lobes of the brain were reduced to a pulp (reduits en 
 bouillie). 
 
 In Trousseau's " Clinique Medicale," the following 
 case is recorded : — In the year 1825, two officers quartered 
 at Tours quarrelled, and satisfied their honour by a duel, 
 as a result of which, one of them received a ball which 
 entered at one temple and made its exit at the other. 
 The patient survived six months without any sign of 
 paralysis or of lesion of articulation, nor was there the 
 least hesitation in the expression of his thoughts till the 
 supervention of inflammation of the central substance 
 which occurred shortly before his death, when it was 
 ascertained that the ball had traversed the two frontal 
 lobes at their centre. 
 
 M. Berard has published the case of a man who was 
 wounded in the forehead by the explosion of a mine ; on 
 being picked up, the patient was rational and gave an 
 account of the accident ; he walked to the hospital, and 
 when seen there by Berard, he had no paralysis and 
 
FRENCH WRITERS. 33 
 
 spoke well. Death took place in 25 hours, and the 
 autopsy showed destruction of the two internal thirds of 
 the right anterior lobe, whilst the entire left anterior 
 lobe was converted into a jelly, without any trace of 
 organisation.* 
 
 M. Charcot, who has collected a number of observa- 
 tions more or less corroborative of M. Broca's assertions, 
 has, however, recorded the case of a woman, aged 47, 
 who from a fit of apoplexy suddenly became hemiplegic 
 on the right side and aphasia Her intelligence was 
 unaffected, and memory reported as good, but her 
 articulate language was reduced to the monosyllable 
 " Ta," which she was in the habit of repeating several 
 times over ("Ta, ta, ta, ta,") very rapidly and very dis- 
 tinctly every time she tried to answer any question or 
 to communicate her own ideas ; the tongue was perfectly 
 free, and could be moved in every direction. After 
 death, it was found that softening had destroyed the 
 first and second convolutions of the temporo-sphenoidal 
 lobe, the island of Reil, the extra-ventricular nucleus of 
 the corpus striatum, and the intra-ventricular nucleus in 
 its posterior half, the optic thalamus being intact; the 
 frontal convolutions presented no alteration either in 
 volume, colour, or consistence, the examination being 
 conducted with the greatest care, and even in the 
 presence of M. Broca, who frankly admitted this case to 
 be at variance with his hypothesis. f 
 
 A woman, aged 73, was admitted into La Salpetriere 
 under M. Vulpian, her only symptom being loss of the 
 power of speech ; there was no paralysis of limbs, and 
 
 * Bulletin de la Societe Anatomique, 1843, p. 121. 
 t Broca, op. cit., p. 6. 
 
34 APHASIA, OR LOSS OF SPEECH. 
 
 M. Vulpian looked upon this patient as a type of aphasia. 
 After a few days she became hemiplegic on the right 
 side, and died of pneumonia five weeks after admission. 
 At the autopsy, softening was observed to a considerable 
 extent in the posterior half of the supra-ventricular 
 white matter of the left hemisphere, there being not the 
 slightest indication of any lesion of the frontal or other 
 convolutions ; there was, however, obstruction of the left 
 middle cerebral artery, caused partly by atheromatous 
 thickening of the walls, and partly by a fibrinous deposit 
 evidently of a recent date, the result rather of a throm- 
 bosis than of an embolism. 
 
 A man, aged 42, was admitted into the Hotel Dieu, 
 under the care of M. Trousseau, on 25th March, 1865. 
 The sister of the ward, deeming him to be in extreme 
 danger, began to exhort him to think about his last 
 moments, when she received for an answer, u N'y a pas 
 de danger." Soon afterwards the dresser arrived, and 
 to his first question the patient replied, "N'y a pas de 
 danger!' Second question, same answer. It was evi- 
 dent that the man was aphasic, and the discovery that 
 there was paralysis of the right side of the body 
 confirmed the diagnosis. There was marked rigidity of 
 the right upper extremity, the forearm being strongly 
 flexed upon the arm ; the tongue was protruded straight, 
 and was freely movable ; the right half of the face was 
 paralysed, but the orbicularis palpebrarum was un- 
 affected. Some weeks after admission he seems to have 
 forgotten his old formula, for to every question he 
 answered, " Tout de mime" Death occurred after four 
 months' residence in the hospital, when the necropsy 
 gave the following results. Almost the entire left 
 hemisphere was converted into a vast cavity, having 
 
FRENCH WRITERS. 35 
 
 the appearance of a true cyst, the walls of which were 
 formed above by a very thin layer of cerebral matter 
 flattened and even softened, and which was adherent to 
 the much-thickened pia mater; in front and behind, all 
 the remaining cerebral substance was yellowish and 
 much softened. The orbital convolutions, the island of 
 Reil, and the first and second frontal convolutions were 
 in a perfectly normal condition ; the third frontal con- 
 volution was pronounced healthy in that portion (the 
 posterior third or half) which bordered the fissure of 
 Sylvius and the furrow of Rolando, but it was evidently 
 softened and almost destroyed in its upper part, where 
 it was included in the general softening of the hemi- 
 sphere, which also involved the corpus striatum and the 
 thalamus opticus ; the middle cerebral artery was not 
 obliterated. This examination was made in the presence 
 of Professors Trousseau and Guillot, and whilst showing 
 the care with which this subject is being investigated by 
 the French faculty, it possesses an additional interest 
 from the fact that when the autopsy was completely 
 finished and the brain mutilated by the successive slices 
 that had been made, M. Broca arrived, and declared that 
 the postero-external part of the third frontal convolution 
 was yellow and softened, and that it had been thought 
 healthy because it had been looked for where it did 
 not exist.* 
 
 A man, aged 31, fractured his skull by falling back- 
 wards, and was admitted into the hospital at Rouen, 
 under M. Flaubert ; the patient lived 24 hours, and pre- 
 sented no symptoms either of aphasia or of paralysis, 
 although at the autopsy the following lesions were dis- 
 
 * "Gazette des Hopitaux," Sept. 28, 1865. 
 
36 APHASIA, OR LOSS OF SPEECH. 
 
 covered : — In the right hemisphere, the anterior and 
 inferior extremity of the frontal lobe was destroyed, 
 softened, and infiltrated with blood ; the three frontal 
 convolutions were affected, the third only in its anterior 
 half. In the left hemisphere, there was complete de- 
 struction of the frontal lobe as far as the transverse 
 frontal convolution, a pulpy mass only remaining con- 
 sisting of a mixture of blood and cerebral matter; the 
 convolutions of the island of Reil were flattened in both 
 hemispheres.* 
 
 The last case to which I shall allude under this head 
 is recorded by M. Langaudin, of Nice, the subject of it 
 being a soldier, who discharged the contents of a pistol 
 through the mouth, the ball traversing the arch of the 
 palate in the median line ; the patient lived two months, 
 and speech was unaffected, although after death it was 
 found that the anterior lobe of the left hemisphere was 
 .entirely destroyed by suppuration. f 
 
 I must not omit to make a brief allusion to Dr. 
 Ladame's essay on lesions of speech in connection with 
 tumours of the brain. From his researches, it would 
 seem that derangement of speech is not common in 
 cerebral tumours, he having observed it only 44 times 
 in 332 observations. According to Dr. Ladame's 
 valuable statistics, tumours of the corpus striatum and 
 of the pons varolii are more frequently attended by loss 
 of speech than those occurring in any other part of the 
 encephalon. He found that tumours in the middle lobes 
 
 * Font-Reaulx, " Localisation de la faculte speciale du langage articule," 
 These de Paris, 1866, Obs. xii. 
 
 f "Gazette des Hopitaux," April 29, 1865. 
 
Professor Charcot's Diagram of Articulate and 
 Written Language. 
 
 I C, Ideational Centre. 
 C A C, Common Auditive Centre. C V C, Common Visual Centre. 
 A C W, Auditive Centre of Words. V C W, Visual Centre of Words. 
 C A L, Centre of Articulate Lan- C W L, Centre of Written Lan- 
 guage, guage. 
 
FRENCH WRITERS. 39 
 
 were more frequently accompanied by lesion of speech 
 than those occupying the anterior lobes, in the propor- 
 tion of five to four. These curious results have led 
 Dr. Ladame to dissent from the doctrine which would 
 place the seat of articulate language in the anterior 
 lobes of the brain. 
 
 Since the publication of my first edition, numerous 
 valuable contributions have been made to the literature 
 of aphasia by French writers, and I would especially call 
 attention to Professor Charcot's clinical lectures at 
 La Salpetriere;* to the highly interesting and logical 
 essay of M. Proust ;f and to the exhaustive treatise of 
 M. Bernard ;% to all of which I shall have occasion to 
 allude in subsequent parts of this treatise. 
 
 Professor Charcot's lectures are illustrated by a 
 diagram of Articulate and Written Language, a short 
 description of which may be interesting to those study- 
 ing the complex and intricate processes involved in the 
 mechanism of speech. 
 
 * It is to be regretted that these admirable lectures, which have given 
 such a stimulus to the study of aphasia, have not yet been published in full 
 in France, although a portion of them has appeared in the " Progres Medical" 
 and other Parisian journals. A complete Italian translation by Dr. Rummo, 
 however, has been published, entitled "Differenti Forme d'Afasia," Milano, 
 1884. 
 
 f " De l'Aphasie," par Adrien Proust, Paris, 1872 ; a work remarkable for 
 its lucidity and incisiveness of exposition. 
 
 X "De l'Aphasie et de ses Diverses Formes." par le Dr. Bernard, Paris, 
 1885. This work is, with the exception of Kussmaul's, by far the most 
 complete treatise on the subject that has come under my notice. It con- 
 tains a full exposition of Professor Charcot's views, and I am indebted to 
 M. Bernard for permission to copy any of the plates from this elaborate 
 work, which I may consider desirable for the better elucidation of my 
 subject. 
 
40 CHARCOTS DIAGRAM OF THE MECHANISM 
 
 A bell is supposed to ring near a child ; the sound 
 makes an impression upon the peripheral expansion of 
 the acoustic nerve, and is conveyed by the nerve itself 
 to a sensitive cell in the cerebral cortex, in that region 
 which constitutes the common auditive centre (C A C), 
 where it forms a deposit, and effects some slight per- 
 manent change. 
 
 The word "bell" is pronounced before the child, and 
 this sound is also conveyed by the acoustic nerve to the 
 auditive centre of words (A C W), the centre specially 
 organised for the intelligent perception of articulate 
 speech. 
 
 The impressions thus produced are registered in the 
 child's ideational centre (I C), and he associates the 
 word." bell" with the recollection of the sound previously 
 heard. 
 
 In order to designate the bell to others by the word 
 thus learnt and retained, and to give outward expression 
 to this "sound image," it is necessary to be able to 
 pronounce it, and the education of a new centre is 
 necessary; the auditive centre of words having supplied 
 the child with an internal image of the sound required, 
 he transfers it to the centre of articulate language (C A L), 
 which enables him to regulate and co-ordinate the 
 movements of the organs for the articulation of words, 
 and the child speaks the word " Bell." 
 
 A similar process is supposed to take place in reference 
 to the visual and graphic aspect of language. 
 
 A bell is placed before the child's eyes, an impression 
 is made upon the retina, and transmitted by the optic 
 nerve to the common visual centre (C V C), where it 
 forms a deposit. 
 
OF ARTICULATE AND WRITTEN LANGUAGE. 4 1 
 
 The written word " bell " is placed before the child, and 
 by means of the optic nerve, the written sign is conveyed 
 to the visual centre of wotds (V C W), and the image 
 thus produced is registered in the ideational centre (I C), 
 as in the case of the auditive bell image. 
 
 In order to enable the child to write the word "bell," 
 the internal image of which has been supplied to him by 
 his visual centre of zvords (V C W), another centre is 
 called into action, the centre of written language (C \V L), 
 and the child is able to write the word "Bell." 
 
 Without committing myself to the expression of an 
 opinion as to the absolute correctness or otherwise of 
 the above elaborate scheme of the learned Parisian 
 professor, I feel it will be of use to me hereafter in con- 
 sidering the various dysphasic derangements described 
 in this treatise. 
 
CHAPTER II. 
 
 Bibliography continued. Schrceder van der Kolk — his theory of the 
 connection of speech with the olivary bodies. German writers — Romberg ; 
 Bergmann ; Hasbach ; Nasse ; Von Benedikt and Braunwart ; Kussmaul. 
 
 FROM the brief summary I have given of the labours 
 of the pathologists of the French school, it will be 
 observed that the evidence deducible therefrom is of 
 such a conflicting character, as to leave quite unsettled 
 the complex question of the localisation of the faculty 
 of speech. The history of the continental contributions 
 to the literature of aphasia would, however, be very 
 incomplete, without a brief glance at the researches of 
 the German and Dutch physiologists. 
 
 Schrceder van der Kolk, in his chapter on the 
 accessory ganglia in the medulla oblongata, endeavours 
 to establish a close physiological and pathological con- 
 nection between the function of articulation and speech 
 and the corpora olivaria. Besides citing numerous cases 
 in illustration of his hypothesis, he gives an a priori 
 reason for his theory in the fact that the corpora olivaria 
 occur only in mammalia — that on comparing these 
 organs as occurring among mammalia themselves, it is 
 
SCHRGEDER VAN DER KOLK'S VIEWS. 43 
 
 to be observed that they nowhere exist on so extensive 
 a scale, and are so fully developed, or present so strongly 
 plaited a corpus ciliare, as in man ; that in the higher 
 mammalia, as the apes, they are most like those in man, 
 and that in man they exceed in circumference by two 
 or three times those of the chimpanzee. To Van der 
 Kolk, these circumstances are suggestive of the idea 
 that in man the corpora olivaria have a much more 
 important function to discharge than in animals; and 
 as these bodies are connected by special fasciculi with 
 the nuclei of the hypoglossus, he looks upon them as 
 auxiliary ganglia of that nerve, and as such, joined to it 
 for the production of special combinations of movement. 
 He also suspects that the very delicate combinations of 
 motion in the human tongue in articulation and speech, 
 may afford an explanation of the much greater size of 
 the olivary bodies, and of their more intimate connection 
 with the nuclei of the hypoglossus. In support of these 
 views, Van der Kolk cites several cases of impairment 
 of the faculty of speech, in all of which there was found 
 after death lesion or degeneration of the olivary bodies. 
 Of these observations the limits of this essay will only 
 permit me briefly to allude to one which seems to me to 
 be particularly pertinent to the subject now under 
 consideration : — 
 
 G. van A., aged 22, had been dumb from birth, but 
 not deaf. She had always enjoyed good health, and 
 although idiotic, usually understood all that was said to 
 her, but had never been able to form an articulate 
 sound, and only now and then uttered a squeak. The 
 patient having died from the effects of diarrhoea, the 
 following appearances were observed at the autopsy. 
 
44- APHASIA, OR LOSS OF SPEECH. 
 
 On removing the hard, but thin and small skull, the 
 cerebrum appeared small and ill-developed ; the con- 
 volutions, especially on the anterior lobes, were slight 
 and not numerous ; in consequence of the diminished 
 arching of the anterior lobes, the so-called convolutions 
 of the third rank of Foville were very small, and scarcely 
 shown on the inner longitudinal surface of the hemi- 
 spheres ; the convolutions on the posterior lobes were 
 also but little developed. On the anterior lobes, beneath 
 the os frontis, was seen a spot of the size of the palm of 
 a small hand, and bloody exudation under the arachnoid, 
 in which situation the pia mater was adherent to the 
 cortical substance which was in many parts softened. 
 On section, the grey and white substances were here and 
 there thickly studded with red sanguineous points; the 
 thalami optici presented a strikingly yellow colour ; the 
 pons Varolii was smaller and narrower than usual, and 
 the corpora olivaria were unusually minute and slightly 
 developed, being less than one-third of the normal size.* 
 
 Van der Kolk, in commenting on this case, remarks 
 that as in this instance there was complete inability to 
 articulate and consequent absence of speech, without 
 deafness and without proper paralysis of the tongue 
 which the patient could move, coinciding with an ex- 
 tremely defective development of the corpora olivaria ; 
 therefore the influence of these bodies on the compli- 
 cated movements of the tongue in speech seemed scarcely 
 to admit of doubt ! 
 
 It will be observed that in laying great stress on the 
 
 * On the Minute Structure and Functions of the Spinal Cord and 
 Medulla Oblongata. Translated by Dr. W. D. Moore, p. 140. 
 
GERMAN WRITERS ; ROMBERG. 45 
 
 fact of the atrophy of the olivary bodies, the learned 
 Utrecht Professor quite loses sight of the deductions to 
 be drawn from the extremely imperfect development of 
 the frontal convolutions, and also from the positive 
 diseased condition of the anterior lobes ; and it seems to 
 me that both Bouillaud and Broca would have a word 
 to say here in favour of their respective theories. 
 
 In further support of his views, Van der Kolk quotes 
 two cases observed by Cruveilhier, in one of which the 
 right corpus olivare had undergone grey degeneration, 
 and in the other both these bodies were found as hard 
 as cartilage. 
 
 Romberg mentions the case of a sailor, who, on being 
 struck on the left side of the head by a loose rope, at 
 once fell into a state of insensibility. After a quarter 
 of an hour he recovered consciousness, but was found to 
 have lost the use of the right half of the body, and to 
 have become speechless. Three weeks afterwards, the 
 mobility of the extremities had been restored, and the 
 tongue could be moved in every direction without 
 difficulty, but the faculty of speech was arrested ; and 
 although perfectly conscious, it was only with the great- 
 est effort that he was able to utter a few inarticulate 
 sounds. Some blood was taken locally on several 
 occasions by leeches applied behind the left ear, a 
 combination of sulphate of magnesia and tartar emetic 
 being administered at the same time ; and in three 
 weeks from the commencement of this treatment his 
 speech returned, and he was completely restored. He 
 also mentions an interesting case of impairment of 
 speech, with partial paralysis of the left side, which after 
 death was seen to depend upon a large tumour, seated 
 
46 APHASIA, OR LOSS OF SPEECH. 
 
 in the right half of the pons Varolii, and extending 
 posteriorly under the right olivary body,* 
 
 Dr. Bergmann, of Hildesheim, has written a masterly 
 treatise on loss of memory and of speech, illustrating it 
 by a series of well recorded cases, to some of which I 
 propose very briefly to refer.f 
 
 A ploughman, Wt., aged 40, of short stature, fell 
 through the trap door of a garret upon the left side of 
 the head. Much blood immediately flowed from the 
 left ear and mouth, the bleeding from the ear continuing 
 for two days. For four weeks he lay stunned and with- 
 out power of recollection ; he heard nothing, his speech 
 was unintelligible, and his eyes were closed. When his 
 consciousness was fully recovered, it was noticed that 
 both eyes were turned towards the nose (there was 
 double convergent strabismus), the pupils were somewhat 
 dilated and sluggish, there was intolerance of light and 
 diplopia ; his memory was observed to have suffered in 
 a peculiar manner — the memory of proper navies and 
 of substantives was abolished, whilst that of things and 
 places remained unimpaired ; and he also had retained 
 the power of correctly speaking and using verbs. He 
 knew what he wished and ought to say, but could not 
 connect the letters of substantives one with another. He 
 knew exactly the place, the way, the streets, and their 
 names, although he was quite unable to give utterance 
 to these names. The same defect was noticed in refer- 
 ence to the furniture, and in fact to every other object. 
 
 * On the Nervous Diseases of Man. Translated by Dr. Sieveking, 
 pp. 310, 407.. 
 
 f Einige Bemerkungen iiber Storungen des Gedachtniss und der Sprache, 
 Allgemeine Zeitschrift fur Psychiatrie, 1849, S. 657. 
 
GERMAN WRITERS ; BERGMANN. 47 
 
 He was shown a penknife, a key, a looking-glass, and 
 he described their use by a pcriphrase. He said of the 
 scissors which were shown him — it is what we cut with. 
 On pointing to the windows he said, it is what we see 
 through — what admits light. 
 
 A man of large stature, strong constitution, and ruddy 
 complexion, with knowing, lively, expressive eyes, for 
 upwards of ten years had never spoken a single word, 
 not even a yes or no, when alone or in company. He 
 heard well, had a good memory and a proper supply of 
 ideas. He wrote a particularly firm and-, correct hand, 
 and was never tired of putting his ideas and foolish fancies 
 on paper. From these written effusions, it was seen that 
 his principal delusion was that he considered himself a 
 great lord and potentate, who sent his decrees and 
 decisions forth to the world. He was always accusing 
 others, but in the most dignified language ; and he 
 commanded and gave his instructions after the manner 
 of one learned in the law of the highest courts of appeal. 
 It was evident that he had intelligence, but a perverted 
 one ; he heard and understood, as his written answers 
 and other behaviour clearly showed. He was docile, he 
 Waited on the other patients like a brave nurse, and 
 willingly employed himself with ordinary handiwork. 
 During the many years that this man remained under, 
 observation, no means were left untried to ascertain, 
 whether he could be made to speak ; but no fraud, no. 
 surprise, no sudden or sharp pain, no electric shock, no 
 hot iron, no entreaty, no threat had ever succeeded in 
 extracting from him even the slightest yes or no. 
 
 Dr. Bergmann, in commenting upon this singular case, 
 and in endeavouring to reach the explanation of the 
 physiological and pathological enigma involved in it, 
 
 D 
 
48 APHASIA, OR LOSS OF SPEECH. 
 
 suggests two hypotheses : That there may have been a 
 fixed idea, a fixed will, a caprice, an obstinate strong 
 purpose, his physiognomy seeming to say — I remain 
 still firm and true to myself, I will carry out my purpose, 
 I will triumph, and I will not yield. Then on the other 
 hand, if one considers that he was good-hearted and 
 well-disposed, obliging and friendly, and that he was 
 scarcely ever angry, notwithstanding all the opposition 
 to his wishes, it would seem more probable that there 
 was a real organic inner momentum (inneres organisches 
 Moment), some hidden impediment which produced loss 
 of speech. 
 
 The only remaining case from this author to which I 
 shall allude is that of Anna W., set. 30, who up to the 
 age of twenty was sound in mind and body, when a 
 nervous fever laid the foundation of mental disturbance 
 and chronic headache. After a time weakness of 
 memory was noticed, and she became indifferent, un- 
 feeling, and unsympathising. There was this peculiarity 
 about the memory — that it was particularly weak and 
 almost extinct in reference to subjects of recent date, 
 whilst she could well remember the events of the earlier 
 period of her illness. For upwards of two years she had 
 never spoken a word, however much one roused her, 
 although her manner gave unmistakable evidence that 
 she could hear and understand what she heard. She 
 had thoughts, conceptions, and ideas ; there must then, 
 says Dr. Bergmann, be an organic defect which rendered 
 her unable to give vent to her thoughts by means of 
 words or even by a sound. 
 
 I shall again have occasion to refer to Dr. Bergmann's 
 highly philosophical treatise in another part of this 
 essay. 
 
GERMAN WRITERS : HASBACH ; NASSE. 49 
 
 Dr. Hasbach, of Geldcrn, has recorded the following 
 case of left hefniplegia with aphasia : — A merchant, aged 
 thirty-six, with a robust thick-set body, who, from 
 speculating in the funds, had become in a short time 
 very rich, was suddenly seized in the night after a hearty 
 meal with apoplexy, resulting in complete paralysis of 
 the left arm and leg, and loss of speech. After a month's 
 treatment, the paralysis of the leg had so far subsided 
 that he could walk slowly with the aid of a stick, the 
 upper extremity remaining, however, entirely paralysed 
 and deprived of sensation. With the exception of one 
 single phrase, he did not recover the power of speech, 
 the only words he could articulate being, " gerecliter 
 Gott" which he would repeat a hundred times each day. 
 There was also this remarkable peculiarity, that al- 
 though he could pronounce clearly and distinctly so 
 difficult a phrase as "gerechter Gott," he was quite 
 unable to articulate separately the letters of which this 
 expression was composed.* 
 
 Dr. W. Nasse, of Bonn, has written a valuable essay 
 on defects of speech, in which he mentions the case of 
 a man thirty years of age, who, after repeated attacks 
 of apoplexy, was paralysed on one side of the body, 
 retaining possession of his mental faculties. The move- 
 ments of his tongue were unfettered, and he could make 
 himself understood ; in the middle of his sentences, 
 however, he often applied wrong words, but immediately 
 recognised his mistake, expressed concern for it, and 
 would endeavour to extricate himself from his difficulty 
 by gesture and periphrase. If the required word were 
 named before him, he would repeat it with glib tongue, 
 
 * " Allgemeine Zeitschrift fur Psychiatrie," 1S52, S. 262. 
 
50 APHASIA, OR LOSS OF SPEECH. 
 
 and could also write it down. After repeated attacks 
 of cerebral congestion, the power of speech progressively 
 diminished, and he gradually fell into a state of im- 
 becility. 
 
 Dr. Nasse, in his general remarks, calls attention to 
 the fact that most frequently proper names and substan- 
 tives, words which are first learnt in childhood and 
 which are in more general use, seem to disappear, whilst 
 verbs and adjectives which are acquired later, remain 
 preserved. He also thinks the loss of the memory of 
 words bears no relation to the condition of the muscular 
 power.* 
 
 Von Benedikt and Braunwart have an excellent and 
 exhaustive paper on lesions of the faculty of speech, 
 from which I shall only quote the following case of 
 aphasia from lead poisoning, as reported by Heymann.f 
 
 Jacob Astheiner, journeyman plasterer, aged sixteen, 
 had suffered for many years from time to time, with 
 lasting headache. Eventually, in the otherwise taciturn 
 patient, were observed great vivacity and wantonness, 
 and the ordinary symptoms of plumbism. A few days 
 afterwards he ceased to answer any questions, and was 
 unable to utter a syllable ; there was also agraphia. A 
 fortnight later his speech partially returned, and he 
 spoke a few words very indistinctly, and would for many 
 hours together cry out Va-ater, Mau-auter, and also 
 Hu-unger, with joyful, excited voice. This patient 
 gradually but entirely recovered. 
 
 During the last few years numerous works in reference 
 
 * "Allgemeine Zeitschrift fiir Psychiatrie," 1853, S. 525. 
 t "Canstatts Jahresbericht," 1865; Dritter Band, S. 31. 
 
GERMAN WRITERS. 51 
 
 to the pathology of aphasia have been published in 
 Germany, amongst which I may mention those of 
 Sander, Th. Simon, Samt, Gogol, and Wernicke ; but 
 by far the most important is that of Professor Kussmaul 
 of Strassburg, whose elaborate and exhaustive treatise 
 I have had frequent occasion to consult, and to which I 
 shall again refer in subsequent chapters ; it is a work 
 quite encyclopedic in character, full of valuable informa- 
 tion, and should be in the hands of all who desire to 
 possess a compendium of all that is at present known of 
 the pathology, diagnosis, and treatment of disturbances 
 of the faculty of speech.* 
 
 It will be observed that in some of the preceding 
 cases, the subjects of them were lunatics or persons of 
 weak mind ; in my opinion, they are none the less 
 valuable on that account ; in fact, Broca's first two cases, 
 the publication of which has given rise to so much dis- 
 cussion and research throughout the scientific world, 
 were observed by that distinguished pathologist in an 
 institution devoted to the treatment of the various forms 
 of mental disease. Although aphasia is by no means a 
 very common symptom in the insane, I cannot but think 
 that the alienist physician possesses unusual opportunities 
 for contributing to the solution of what still remains one 
 of the most difficult questions in cerebral pathology. 
 
 * Die Stbrungen der Sprache. Versuch einer Pathologie der Sprache, 
 von Dr. Adolf Kussmaul. Leipzig, 1881. 
 
CHAPTER III. 
 
 Bibliography continued. English, Scotch, and Irish writers. American 
 contributions to the literature of Aphasia — S. Jackson ; Hun ; Bigelow ; 
 "Wilbur ; Austin Flint ; Seguin ; Hammond. 
 
 In the two preceding chapters, I have endeavoured to 
 give a short sketch of the literature of aphasia as illus- 
 trated by continental pathologists, and I now proceed 
 briefly to notice the researches of the different members 
 of the Anglo-Saxon race. 
 
 Amongst British authors the earliest observations 
 that have come under my notice are those of Crichton, 
 who mentions several cases bearing on the subject under 
 consideration, from which I have selected the following : 
 
 An attorney, in his seventieth year, having indulged 
 in great venereal excesses, was suddenly seized with 
 great prostration of strength, giddiness, insensibility to 
 all the concerns of life, and every symptom of approach- 
 ing fatuity. When he wished to ask for anything, he 
 constantly made use of some inappropriate term ; instead 
 of asking for a piece of bread he would probably ask 
 for his boots, and if these were brought he knew they 
 did not correspond tc the idea he had of the things he 
 
ENGLISH WRITERS; CRICHTON. 53 
 
 wanted, and therefore he became angry, yet he would 
 still demand some of his boots or shoes, meaning bread. 
 If he wanted a tumbler, he would ask for a chamber 
 utensil ; and if it happened to be the said chamber 
 utensil he wanted, he would ask for a tumbler, or a 
 dish. He evidently was conscious that he used wrong 
 words, for when the proper expression was employed by 
 another person, and he was asked if it was such a thing 
 that he wanted, he always seemed aware of the mistake, 
 and corrected himself by adopting the appropriate ex- 
 pression. This gentleman was cured of his complaint 
 by large doses of valerian and other proper remedies. 
 
 A man, aged 70, was seized with a kind of cramp in 
 the muscles of the mouth, accompanied with a sense of 
 tickling all over the surface of the body, as if ants were 
 creeping on it. A few weeks later, after having ex- 
 perienced an attack of giddiness and confusion of ideas, 
 a remarkable alteration in his speech was observed to 
 have taken place. He articulated easily and fluently, 
 but made use of strange words which nobody understood, 
 and he himself was conscious that he spoke nonsense. 
 What he wrote was equally faulty with what he spoke. 
 
 Crichton also mentions instances of persons who 
 suddenly found that they could not remember their own 
 names, the most striking being that of an ambassador 
 at St. Petersburg, who, on calling at a house where he 
 was not known by the servants, and wishing to give his 
 name, could not at that moment remember it, and turn- 
 ing round to his companion said, with much earnestness, 
 "For God's sake tell me who I am."* 
 
 * " An Inquiry into the Nature and Origin of Mental Derangement, com- 
 prehending a Concise System of the Physiology and Pathology of the 
 Human Mind." Vol. i., pp. 371, 375, 369. London, 1798. 
 
54 APHASIA, OR LOSS OF SPEECH. 
 
 Of the above cases, the first two are instances of 
 paraphasia ; of the third, it may possibly be thought 
 that it scarcely falls within the range of defects of 
 speech ; it has, however, an indirect bearing upon my 
 subject, and I have therefore deemed it worthy of record. 
 
 Baillie relates the history of a gentleman, aged fifty- 
 six, who, after an attack of right hemiplegia, lost the 
 recollection of the words of his own language, except a 
 very few, "Yes," "No," "Mr. Reed," "Yesterday," 
 which he employed on all occasions, and pronounced 
 with the greatest distinctness, exhibiting none of that 
 thickness in his pronunciation which is so common in 
 paralytic patients ; his countenance expressed a full 
 share of understanding, and he seemed to comprehend 
 all that was said to him. In the account of the necropsy, 
 the brain and its membranes are described as perfectly 
 natural in appearance, but the left vertebral artery was 
 enlarged, and its coats had become opaque. There was 
 considerable effusion into the lateral ventricles, which 
 probably coincided with the occurrence of the coma 
 which set in a few days previous to his death.* 
 
 Bright describes a case of dextral paralysis with 
 aphasia, occurring in a man aged 63, who had a few 
 years before married a woman much younger than him- 
 self ; he had also for several years been the subject of an 
 open ulcer in the leg, which had healed up six or seven 
 months before the paralytic seizure. After death there 
 was found softening of the middle and posterior lobes 
 
 * "Medical Transactions of the College of Physicians,'' 1813, vol. iv., 
 P- 9- 
 
DR. COPLAND; SIR THOMAS WATSON. 55 
 
 of the left hemisphere, the anterior lobe being unim- 
 paired. The vessels at the base of the brain, particularly 
 the carotid and its branches, were very much ossified, 
 and the mitral valve was converted into an irregular 
 bony mass. There is a very beautiful plate appended 
 to the description of this case, from which it would 
 appear that the disease commenced in the cortical 
 portion.* 
 
 Dr. Copland, who has written de omnibus rebus ct 
 quibusdam aliis, has, of course, not omitted to speak of 
 lesions of speech ; our great medical lexicographer, how- 
 ever, seems only to have viewed them as motor defects, 
 and not as due to the loss of an intellectual faculty; 
 and the only case which is given in detail in his work on 
 apoplexy, is clearly one of disease at the origin of the 
 lingual and glosso-pharyngeal nerves, and not an instance 
 of lesion of the faculty of articulate language.! 
 
 Sir Thomas Watson relates a remarkable case of a 
 gentleman, who had a sudden fit of apoplexy, for which 
 he was freely bled, and who on the third day was 
 apparently quite recovered. On the fifth day, after a 
 long conversation, he suddenly lost the thread of his 
 discourse, became confused, and misappropriated words — 
 for instance, wishing to say " camphor," he called it 
 " pamphlet." After a (q\v days the right side of the 
 body became paralysed, and he died at the expiration 
 of a fortnight from the commencement of the attack. 
 At the post mortem, an abscess was found at the upper 
 part of the left hemisphere, in the centre of which was 
 
 * Reports of Medical Cases, Vol. ii., p. 177. 
 t Copland on Palsy and Apoplexy, p. 37. 
 
56 APHASIA, OR LOSS OF SPEECH. 
 
 a small fibrous tough mass of dull red colour, the 
 coagulum doubtless of blood effused at the period of 
 the apoplectic seizure.* 
 
 Dr. Todd mentions several instances of hemiplegia 
 with aphasia, the paralysis being, with one exception, 
 always on the right side. In one case only the post 
 mortem appearances are given, with Dr. Todd's usual 
 attention to details. The hemiplegia was explained by 
 disease of the central ganglia, but there was likewise 
 considerable softening (colourless) of the white substance 
 of the hemisphere, where were numerous small vessels 
 in a state of fatty degeneration, and also an abundance 
 of compound cells. The grey matter was not stated as 
 being affected. f 
 
 Dr. Todd's attention was evidently never given to the 
 special consideration of speechlessness as a symptom of 
 brain disease, and in one case, he says, "it was evident 
 that very grave lesion had occurred, sufficient to inflict 
 so severe a shock on the brain as to destroy the power 
 of speech." 
 
 Dr. Forbes Winslow, in his remarkable chapter on 
 the " Morbid Phenomena of Speech," has entered with 
 considerable detail into the question of the cerebral 
 localisation of that faculty, illustrating the subject 
 by allusion to a number of highly interesting cases, from 
 which I have selected the following for brief allusion.* 
 
 A gentleman had an attack of apoplexy, consequent 
 upon extravasation, the effects of a rupture of one of the 
 
 * Practice of Physic, Vol. ii., p. 511. 
 
 f Clinical Lectures on Diseases of the Brain, p. 247. 
 
 % On Obscure Diseases of the Brain, p. 497. 
 
ENGLISH WRITERS; FORBES WINSLOW. $? 
 
 cerebral vessels. He rallied, had a second attack, and 
 again recovered. At the expiration of eighteen months 
 a third attack ensued, when he became hemiplegic and 
 entirely lost his speech, and died in two months, having 
 never uttered a vocal sound. At the examination, a 
 small patch of softened brain was found in the pons 
 Varolii, surrounding a clot which had been deposited 
 on that ganglion. The other portions of the cerebral 
 mass were apparently in a healthy condition, with the 
 exception of some of the vessels being closed by deposits 
 of bony matter. 
 
 A patient suffering from cancer of the uterus, which 
 completely prostrated her, was suddenly seized, in the 
 middle of the night and without any known cause, with 
 an almost complete dumbness, which only enabled her 
 to say "yes, yes," to all questions, whether they were 
 contradictory or not. She retained possession of her 
 intelligence, for she was neither paralysed nor insane. 
 If she was requested to write what she had to communi- 
 cate, she traced an assemblage of letters on the paper 
 to which no meaning could be attached. 
 
 A clergyman, whilst reading the Litany, became 
 suddenly speechless, without losing his consciousness, 
 and was obliged to leave the church. He continued in 
 the same state for an hour, being perfectly sensible of 
 everything that was going on about him, and was able 
 to write on a piece of paper a request that a certain 
 physician should be immediately summoned. Two 
 days after the loss of speech, he was in a state of 
 apoplectic coma, in which he died, no autopsy being 
 permitted. 
 
 A gentleman, after many premonitory warnings, fell 
 down in a fit, described as a combination of epilepsy 
 
58 APHASIA, OR LOSS OF SPEECH. 
 
 and apoplexy, and for two days his life was in imminent 
 danger ; he, however, partially recovered, but with an 
 inability to give anything like a clear expression to his 
 wishes, what he said being quite unintelligible. He 
 was able to pronounce words with great clearness, but 
 they were sadly misplaced and transposed. By adopt- 
 ing the course of writing down what he said, and then 
 re-arranging the words in their proper order, his family 
 were able clearly to understand his wishes. This state 
 of brain and impairment of speech continued with slight 
 intermission for nearly a fortnight, accompanied by 
 acute pain in the occipital region. Abstraction of 
 blood by cupping was followed by a decided mitigation 
 of the symptoms. Mercurial purgatives were adminis- 
 tered, the head was shaved, and counter-irritation 
 applied behind the ears. At the end of five days he 
 was able to converse coherently for a few minutes, but 
 if he continued in conversation beyond that time, he 
 again began to jumble and misplace his words. Minute 
 doses of bichloride of mercury in combination with 
 tincture of cinchona, were subsequently administered 
 with the greatest benefit, and in the course of a few 
 months he entirely recovered. 
 
 Dr. Winslow adds that in fifty-four cases he has 
 detected after death a considerable amount of disease of 
 the anterior lobes without being accompanied during 
 life with any perceptible loss of speech. In one case of 
 softening of the cerebellum, the principal symptom was 
 great perversion of the faculty of speech, without com- 
 plete loss of power over this function, the anterior lobes 
 being free from all organic alteration. In another case 
 a large encysted abscess was discovered at the base of 
 the brain, which produced during life the most singularly 
 
ENGLISH WRITERS. 59 
 
 remarkable modification of the faculty of speech, the 
 patient's misplacement of words being at times most 
 eccentric and grotesque, and the power of articulation 
 seeming occasionally to be entirely lost. In a third case 
 a tumour of a malignant character was found in the 
 cerebellum, which produced complete loss of speech. 
 
 The next observation to which I shall direct attention 
 is one of extreme interest from its exceptional character, 
 being a case of impairment of the faculty of articulate 
 language from disease of the spinal cord, reported by 
 Dr. Maty in the third volume of the " London Medical 
 Observations and Inquiries." 
 
 The Count de L., aged 35, was overturned in his 
 coach from a high and steep bank ; the accident was 
 followed by no head symptoms, and he soon recovered 
 from the effects of a severe contusion of the left shoulder, 
 arm, and hand, and went through the fatigues of a 
 military campaign. Six months afterwards, however, 
 weakness of the left arm occurred, with difficulty of 
 articulating certain words. Some months later the diffi- 
 culty in speaking and in moving the left arm increased ; 
 the limb eventually became withered, and he could 
 scarcely utter a few words, and those only monosyllables. 
 During all this time the Count continued able to read 
 and write, and spent his time in the most abstruse sub- 
 jects, and up to the period of his death, which occurred 
 four years after the accident, he preserved to the last the 
 highest intellectual power. The description of the 
 autopsy is too minute to admit of its being given here 
 in detail ; the medulla oblongata was enlarged by one- 
 third, and more compact than natural, and the spinal 
 membranes were very tough. The spinal marrow itself 
 
60 APHASIA FROM THE RUPTURE OF A 
 
 had acquired such a solidity as to elude the pressure of 
 the fingers, and to offer the resistance of a callous body, 
 this peculiarity being most apparent in the cervical 
 portion. 
 
 The following unique case of aphasia, resulting from 
 the rupture of a vessel within the orbit, was com- 
 municated to the Norwich Pathological Society by my 
 colleague, Dr. Copeman, who had extracted it from the 
 private notes of the late Mr. Norgate. 
 
 Sarah Hase, aet 29, a spare, slender woman, in good 
 general health, and in the last stage of pregnancy, was 
 seized with an acute lancinating pain in the left side of 
 the head and temple, extending deep into the orbit ; the 
 eyelids became swollen, and she experienced a throbbing 
 and constant "boiling" just above the brow. At five 
 o'clock the following morning, with very little effort 
 and before the midwife could arrive, she was delivered 
 of a child. Soon afterwards the pain and distension 
 caused by pressure on the ocular globe from behind 
 became almost intolerable ; and it now became quite 
 evident that a vessel of some size at the back of the 
 orbit had been ruptured. Leeches were now plentifully 
 applied around the part, followed by cold lotions. In 
 the evening of the same day, the eye was noticed to be 
 protruding and nearly immovable from pressure, and it 
 was now that for the first time Mr. Norgate noticed a 
 remarkable hesitation in answering questions, although 
 she was perfectly conscious ; she occasionally employed 
 one word for another, mistook letters, and dropped 
 syllables in articulating words. The next day the eye- 
 ball was more perfectly fixed, the agony was extreme, 
 and although the cornea was then clear, the retina was 
 
VESSEL WITHIN THE LEFT ORBIT. 6 1 
 
 amaurotic, and the iris quite insensible to light, vision of 
 course being lost. She now confused her words so much 
 as to be quite unintelligible to those around her ; she 
 tried to make it understood by signs that she wished to 
 write, and in attempting to do so she invariably made 
 use of parts of words. Omitting the daily details, suffice 
 it to say that after scarification of the conjunctiva and 
 other appropriate treatment, there was a little relaxation 
 of pressure ; the globe was less distended, and the power 
 of expressing herself began to improve ; in proportion 
 as absorption proceeded, so the power of language in- 
 creased, and in a few days she could articulate and 
 converse as well as ever. This patient told Mr. Norgate 
 afterwards that she comprehended everything that was 
 said during the period in which she had been unable to 
 express herself. 
 
 The above case is, I think, unique of its kind, although 
 a somewhat similar one is quoted by Van der Kolk, 
 from the " Gazette Medicale de Paris," of September 5th, 
 1857, where it is stated that in consequence of a wound, 
 a bony splinter from the os frontis above the left eye 
 compressed the anterior part of the hemisphere, subse- 
 quently causing loss of speech, which faculty was com- 
 pletely regained after the removal of the fragment by 
 the trepan. 
 
 I would call attention to the fact that the inference to 
 be drawn from these two cases is not in favour of the 
 theory of M. Broca, but rather favours the system of 
 Gall, who located the faculty of language in that part of 
 the anterior lobes which lies above the orbital plates ; 
 for it was clearly this region that was the seat of pressure 
 in both cases, and not the neighbourhood of the so-called 
 Broca's region. 
 
62 APHASIA, OR LOSS OF SPEECH. 
 
 The next case I shall mention was also observed by a 
 Norwich pathologist — my colleague, Mr. Cadge, having 
 at one of the meetings of the Norwich Pathological 
 Society, related the following case of a cerebral tumour 
 sufficiently large to take the place of the left anterior 
 lobe, speech continuing unaffected to the last. 
 
 C. D., set. 50, was a strong stout man, remarkable for 
 his physical power and invariable good health, and 
 moderately temperate in his mode of life. Although 
 not an ill-tempered or violent man, he had a habit of 
 wrangling with, and abusing those in his employ; he 
 was addicted, in fact, to a kind of chronic vituperation, 
 which meant little, but sounded a good deal, for he had 
 a loud voice and a copious vocabulary. The first in- 
 dication of his illness that attracted notice, was that 
 he ceased to upbraid, and became suspiciously good- 
 humoured and quiet ; this change in his manner occurred 
 only six months before his death. The next symptom 
 was violent but intermitting headache ; at first it was 
 almost confined to the back of the head, afterwards it 
 passed over to the forehead, but was never restricted to 
 one or other side of the head ; he also had a constant 
 singing in the left ear. His sight soon became defective, 
 and about three months before death he became totally 
 blind, large retinal extravasation being observable by 
 the ophthalmoscope. As the sight failed, his mind and 
 faculties began to waver, and he became droll and 
 almost childish. At no period of his illness was there 
 any continued paralysis ; on one occasion he staggered 
 and fell whilst walking, but quickly recovered. Other 
 than this, there was no loss of power or sensation ; his 
 voice was clear and his articulation distinct. Six months 
 from the commencement of his illness he suddenly 
 
ENGLISH WRITERS ; CASE OF CEREBRAL TUMOUR. 63 
 
 became apoplectic and comatose, and died in twelve 
 hours. 
 
 Necropsy: — The cerebral membranes were adherent; 
 there was nothing like excessive congestion in any part, 
 nor was there more than a little excess of fluid either in 
 the ventricles or at the base of the brain. There was 
 some trouble in peeling off the membranes from the 
 convolutions, this being as much or more due to over 
 softness of the latter than to unnatural adhesion ; nothing 
 like inflammation or active congestion was present. 
 Hidden in the left anterior lobe of the brain was a 
 tumour of about the size of a hen's egg ; the tissue 
 around it being considerably softened, it was not easy 
 to ascertain very precisely its exact limits and relations. 
 It seemed to occupy the left lobe chiefly, encroaching 
 slightly on the right across the corpus callosum ; behind 
 it pressed on the corpus striatum, and was visible in the- 
 anterior cornu of the ventricle; in front it encroached 
 upon the grey matter of the convolutions, but did not 
 reach the surface ; below it rested on the root of the 
 orbit and on the olfactory nerve. The tumour itself was 
 of softish consistency, not unlike tubercular matter ; in 
 some parts it had almost a gelatinous aspect, and under 
 the microscope nothing was visible but a multitude of 
 compound cells and free nuclei, and a few large cor- 
 puscles, but no fibrous structure whatever. 
 
 After stating that the inference was that the tumour 
 was malignant, (its rapid development encouraging that 
 view,) Mr. Cadge asks, why a tumour in the anterior 
 lobe should cause blindness, as there was no pressure on, 
 or inflammation around, the optic nerves, nor were the 
 optic thalami or tract at all interfered with ? He also 
 asks how it is that there was neither aphasia nor paralysis 
 
 E 
 
64 APHASIA, OR LOSS OF SPEECH. 
 
 of the right side ? This last question of Mr. Cadge I 
 shall endeavour to answer in a subsequent part of this 
 work, when analysing the mass of evidence I have 
 collected, with the view of testing the value of the 
 different statements that have been made as to the seat 
 of the faculty of speech. 
 
 Mr. Dunn, whose researches in physiological psycho- 
 logy are so well known, has published several very 
 interesting cases of loss or impairment of speech, to one 
 only of which I shall briefly refer. 
 
 A young girl, aged eighteen, accidentally fell into a 
 river, from which she was extricated in a state of 
 suspended animation ; prompt assistance being rendered, 
 sensibility was restored, and she eventually recovered. 
 Ten days afterwards she was seized with a fit, lay in a 
 state of complete stupor for nearly four hours, on rally- 
 ing from which, it was observed that she had lost the 
 power of speech and hearing, and was also deprived of 
 the senses of taste and smell, and for three months her 
 only medium of communication with the external world 
 were the senses of sight and touch. About three 
 months afterwards, an incident occurred in the family 
 which roused her sensibility and suddenly brought into 
 play one of her suspended powers — the faculty of speech. 
 
 Seeing her mother in a state of excessive agitation and 
 grief, she became excited herself, and in the emotional 
 paroxysm of the moment, she suddenly ejaculated, 
 " Wh — a — t's the mat — ter ? " From this time she 
 began to articulate a few words, but she neither called 
 persons nor things by their right names. Nine months 
 later, under sudden and overwhelming emotional ex- 
 citement, she fell into a state of insensibility of many 
 
ENGLISH WRITERS; DR. HUGHLIXGS JACKSON. 65 
 
 hours' duration, but which proved critical and sanatory, 
 for she awoke in possession of her natural faculties and 
 former knowledge ; her speech was restored, but she 
 had not the slightest recollection of anything that had 
 taken place during the interval of the twelve months 
 that her faculties had been suspended. 
 
 Beyond all doubt the observer who has done the most 
 in this country to elucidate the subject of cerebral loss of 
 speech is Dr. Hughlings Jackson, who, in the London 
 Hospital Reports for 1864, has given the details of thirty- 
 four cases of hemiplegia with loss of speech. Of these 
 cases, the paralysis was observed thirty-one times on the 
 right side and three times on the left ; the heart was 
 more or less affected in twenty instances (valvular disease 
 existing in thirteen cases) ; in four cases there was loss 
 or defect of smell. I much regret that want of space 
 will not allow me to dwell on this most interesting com- 
 munication ; there are, however, two cases in this 
 collection to which I must briefly allude. One is a case 
 of aphasia with left hemiplegia occurring suddenly in a 
 gentleman 64 years of age, who fourteen years before 
 had received a very severe blow in the right occipital 
 region, which had left him ever afterwards deprived of 
 the power of smell and taste. In the other case the 
 patient, although continuing aphasic, had recovered the 
 power to swear, which Dr. Jackson explains on the 
 principle that ejaculatory expressions are prompted by 
 the emotions and not by the will; he also considers that 
 oaths and similar interjectional expressions are not parts 
 of speech in the broad sense in which the words that 
 form them are, when used to convey intellectual pro- 
 positions. 
 
66 EXTENSIVE LESION OF THIRD LEFT 
 
 In a more recent article in Reynolds' " System of 
 Medicine," Dr. Jackson observes that the association of 
 defects of- speech with symptoms pointing to disease 
 of the left hemisphere is not so striking in children as 
 in adults. 
 
 The medical journals of the last few years contain a 
 variety of interesting cases, to the salient points of which 
 only a passing allusion can be made. 
 
 In the "Medical Times" of July 9th, 1864, a case is 
 recorded of a man aged twenty-one who was admitted 
 into the Middlesex Hospital, under Dr. Stewart, with 
 left hemiplegia without loss of speech, the attack having 
 been preceded by choreic movements of the left arm 
 and leg. A week later he was suddenly seized with 
 paralysis of the right side, with loss of speech ; con- 
 sciousness, however, being retained. After death both 
 middle cerebral arteries were filled with fibrinous plugs 
 and semi-coagulated blood ; at each end of the Sylvian 
 fissure was a mass of diffluent brain substance, of about 
 the size of a walnut. 
 
 In the "British Medical Journal " for December 14th, 
 1867, Dr. Bastian reports a case of right hemiplegia with 
 aphasia, where after death the arteries at the base of 
 the brain were all notably diseased and contained large 
 white calcified patches at intervals ; the left hemisphere 
 showed very many patches of red softening, which were 
 almost always strictly confined to the grey matter of 
 the convolutions, the principal patches of softening being 
 met with in the third or inferior frontal convolution, in a 
 portion of the adjacent ascending parietal* near its 
 
 * I presume Dr. Bastian means the posterior or ascending frontal. 
 
FRONTAL CONVOLUTION WITHOUT APHASIA. 67 
 
 commencement, and in the superior frontal. The great 
 mass of the white matter of the hemisphere appeared 
 healthy and of normal consistence, as also the central 
 ganglia, pons, and medulla. The heart was large, 
 weighing eighteen ounces ; the aortic valves and a por- 
 tion of the great tongue of the mitral, showed a very 
 early atheromatous change. 
 
 One of the most recent observations that have fallen 
 under my notice is that recorded by Dr. Simpson, in 
 the "Medical Times" of December 2tst, 1867, as a case 
 of "Extensive Lesion of the third left frontal convolu- 
 tion of the cerebrum without aphasia." W. M., aet. 62, 
 was admitted into the Gloucester County Asylum, in 
 February, 1857, and had been subject to epilepsy from 
 his early youth ; he never had an apoplectic attack as 
 far as could be ascertained, nor had he at any time 
 suffered from loss of speech. During the ten years he 
 was under observation in the asylum, he had no brain 
 symptoms beyond those ordinarily associated with 
 epilepsy, no paralysis, and no impairment of speech. 
 He died in November, 1867, of bronchitis. 
 
 Autopsy: — Calvarium thick and heavy ; cranium un- 
 symmetrical, being elongated in the left oblique diameter. 
 Dura mater non-adherent and healthy; arachnoid opaque 
 throughout, but more particularly on the upper parts of 
 both hemispheres ; pia mater normal. The grey matter 
 was somewhat atrophied, of firm consistence, but paler 
 than normal ; white matter also atrophied, and the 
 interspaces and ventricles filled with serum. Both 
 orbital divisions of the frontal lobes were indented, from 
 undue prominence of the upper walls of the orbits. On 
 the left side, and implicating the posterior part of the 
 
68 APHASIA, OR LOSS OF SPEECH. 
 
 third or inferior frontal convolution, a large depression 
 existed which appeared to be the remains of an apoplectic 
 clot ; it was of irregular shape, about an inch and three- 
 quarters in its antero-posterior, and an inch and a half in 
 its transverse diameters ; extending internally to within 
 five lines of the olfactory bulb, and in front to within an 
 inch of the anterior margin of the hemisphere ; it was 
 deepest in the centre, where it measured half an inch 
 from the general line of surface. The brain tissue was 
 stained of a brownish-yellow colour, and there was con- 
 siderable puckering, with induration round the margins 
 of the depression. Microscopical examination showed 
 distinct feathery crystals of hsematoidin. The cortical 
 substance was greatly thinned, being reduced to a mere 
 line in the centre of the depression ; the island of Reil 
 appeared healthy, and the other parts of the brain pre- 
 sented no great deviation from the normal standard ; the 
 cerebral arteries were slightly atheromatous. Weight of 
 encephalon, 42^ oz. 
 
 These three cases, the leading features only of which 
 I have just described, are of extreme interest from the 
 circumstance that in all of them the clinical history is 
 completed by a minute and well-recorded description of 
 the post-mortem appearances. The first case is remark- < 
 able from the fact that the patient possessed the power 
 of speech in its perfect integrity whilst the paralysis was 
 confined to the left side ; but, having to a great extent 
 recovered from this first attack, a sudden invasion of 
 dextral paralysis was immediately followed by loss of 
 speech. The second case, that of Dr. Bastian, will be 
 claimed by M. Broca and his advocates in support of 
 their theory as to the localisation of speech, for there is 
 
ENGLISH WRITERS. 69 
 
 a high probability that the diseased action may have 
 commenced in the third or inferior frontal convolution 
 and its neighbourhood, as the greatest amount of soften- 
 ing was observed in this region ; another interesting 
 feature in the case was the existence of complete hemi- 
 plegia, with only disease of the convolutional grey matter 
 to account for it. This remarkable communication, 
 which is written in Dr. Bastian's usual clear and lucid 
 style, is well worthy of a careful study, being pregnant 
 with original thought and the results of philosophical 
 research. The case of Dr. Simpson is unique, and can- 
 not be dismissed without a word of comment. Here 
 there was disease of the posterior part of the third left 
 frontal convolution, (the exact region of Broca,) without 
 any impairment of speech. I have already mentioned 
 cases of aphasia where the frontal convolutions were all 
 described as healthy, and I shall have others to record, 
 which have occurred under my own immediate obser- 
 vation ; but hitherto we have had no example of the 
 converse condition, that is, disease of tJie third left frontal 
 convolution without lesion of speech, and it has even been 
 stated that there is no case on record in which positive 
 disease of this precise spot existed with integrity of 
 speech. 
 
 The researches of our northern neighbours, the Pro- 
 fessors of the " Modern Athens" must be considered as 
 most valuable contributions to the literature of the 
 subject we are now discussing. 
 
 Abercrombie, whose work on cerebral disease is per- 
 haps more quoted than that of any other British author 
 of the past generation^ has recorded numerous cases of 
 
70 APHASIA, OR LOSS OF SPEECH. 
 
 cerebral loss of speech, of which I can only briefly 
 allude to the following, which are in direct opposition 
 to the recent theories as to the seat of the faculty of 
 articulate language. 
 
 A man, aged fifty, who had been for some time 
 subject to cough and bloody expectoration, was seized 
 with frontal headache and some confusion of thought, 
 which appeared chiefly in a tendency to misapply words ; 
 he soon lost the sight of the right eye, his speech became 
 indistinct, and, after some time, inarticulate ; and he 
 died in two months from the commencement of the 
 cerebral symptoms. At the autopsy there was found, 
 at the posterior part of the left hemisphere, a soft and 
 vascular cyst, containing about two ounces of a thick, 
 colourless fluid, coagulable by heat, and exactly re- 
 sembling the albumen of an egg', the cerebral substance 
 around the cyst was softened, the brain in other respects 
 being healthy. 
 
 A man, aged sixty, after some premonitory symptoms, 
 was suddenly attacked with left hemiplegia and inarticulate 
 speech, his intelligence, however, being unimpaired. At 
 the end of a month he was suddenly seized with perfect 
 loss of speech, which was followed in a few hours by 
 coma, from which he did not recover. The substance 
 of the brain was found healthy, except at the outer 
 part of the right hemisphere, where there was a con- 
 siderable portion in a state of complete ramollissement. 
 The pia mater on the upper part of both hemispheres 
 appeared thickened, and was remarkably vascular; 
 there was considerable subarachnoid effusion, and both 
 lateral ventricles were distended with fluid. 
 
 The same author mentions the case of a child, four 
 years and a half old, whose articulation had been for 
 
SCOTTISH WRITERS. 7 1 
 
 many months very imperfect, and at whose autopsy the 
 corpora olivaria, the crus cerebelli, and the tubercula 
 mammillaria were found in a state of cartilaginous hard- 
 ness ; other parts being sound.* 
 
 In the report of the Edinburgh Asylum for 1866, 
 Dr. Skae relates a case of right hemiplegia where the 
 patient had lost the power of all articulate speech, except 
 the words, "aye, aye," and at whose autopsy an effusion 
 of blood was found in the left posterior lobe of the brain. 
 
 Dr. Sanders and the late Dr. Scoresby Jackson have 
 recorded a case with autopsy, more or less corrobora- 
 tive of Broca's theory. 
 
 The subject of Dr. Sanders' case was a woman aged 
 43, who was admitted into the Royal Infirmary at 
 Edinburgh, on November 16th, 1865, with incomplete 
 paralysis of the right side, defective speech, and loss of 
 the memory of words. Without following Dr. Sanders 
 in his detailed account of the clinical history of this case, 
 suffice it to say that two days after admission the patient 
 complained of pain in the left leg, with impaired motion 
 and anaesthesia ; signs of obstruction of the left femoral 
 artery showed themselves, and gangrene of the corre- 
 sponding limb occurred, from the effects of which she 
 died about two months from the date of her admission. 
 Autopsy : — The right hemisphere presented no lesion. 
 On carefully examining the left hemisphere, the posterior 
 part of the inferior left frontal convolution, where it forms 
 the anterior margin of the fissure of Sylvius, together 
 with a small portion of the adjoining orbital convolution, 
 was observed to be collapsed, and depressed below the 
 
 * "On Diseases of the Brain and Spinal Cord," pp. 176, 273, 431. 
 
72 APHASIA, OR LOSS OF SPEECH. 
 
 natural level. The flattened and depressed portions felt 
 soft and fluctuating to the touch, and on cutting into the 
 softened part, the grey matter was found to be thinned 
 off from within, and the white cerebral substance was 
 completely softened and eroded, presenting an appear- 
 ance like dirty cream. The softening extended inwards 
 to the immediate neighbourhood of the corpus striatum, 
 without, however, involving it. The other convolutions 
 of the anterior lobe were not affected, but there existed 
 a separate softening near the posterior extremity of the 
 fissure of Sylvius. The corpora olivaria were normal, 
 and there was no other lesion of the encephalon. There 
 was no embolism in the cerebral arteries, but there was 
 a little thickening in the wall of the artery of the left 
 Sylvian fissure.* 
 
 In Dr. Scoresby Jackson's case, the subject of it, 
 James A., 48 years of age, was thrown from a van and 
 received a wound on the left temple. This accident did 
 not prevent him from working, but he ever afterwards 
 complained of a pain in the head ; and two months 
 after the injury he was suddenly seized with right 
 hemiplegia and aphasia, and died seven weeks later. 
 Autopsy : — The heart was of natural size, and on the 
 mitral valve were numerous vegetations, and loose 
 fibrinous masses. The vessels at the base of the brain 
 were atheromatous at several points, and there was 
 
 * After the above lines were written, I was favoured with a private 
 communication from my lamented friend, the late Professor Sanders, 
 in which he informed me that his later dissections tended to show that in 
 speech-palsy it is the island of Reil that is at fault rather than Broca's 
 convolution. For the details of cases published by Dr. Sanders in support 
 of this view, see " Lancet" for June 16th, 1866, and "Edinburgh Medical 
 Journal " for August, 1866. 
 
SCOTTISH WRITERS: GAIRDNER; ROBERTSON. 7$ 
 
 embolism in some of the branches of the left middle 
 cerebral artery. There was softening of a considerable 
 portion of the left hemisphere, which was most advanced 
 in the island of Reil and in the posterior part of the third 
 frontal convolution, the anterior end of the same gyrus 
 not being involved.* 
 
 Dr. Gairdner, of Glasgow, has published an extremely 
 interesting case of epileptic seizure, followed by a 
 speechless and somewhat cataleptic state, without coma 
 or evident paralysis. There was recovery of the in- 
 telligence to a considerable extent, but with continued 
 aphasia, death ensuing in ten weeks during an epileptic 
 paroxysm. This patient, although unable to express 
 himself in writing, was able to copy handwriting set 
 before him with tolerable accuracy. The necropsy, 
 which was made with great care, revealed no cerebral 
 lesion whatever beyond general and diffused congestion 
 of the vessels of the pia mater, the smaller ones of 
 which were surrounded with slight granular deposit." f 
 
 Dr. Robertson, of Glasgow, after giving a most in- 
 teresting account of three typical cases observed by 
 himself, gives the following summary of the views he 
 entertains as to the cause of aphasia: — "There is a 
 lesion usually in the left hemisphere of the brain, of 
 efferent fibres passing between the convolutions and the 
 great co-ordinating centres, probably at some point of 
 a line extending from the external frontal convolu- 
 tion to the corpus striatum, so that voluntary motor 
 
 * "Edinburgh Medical Journal," February, 1867. 
 t "Glasgow Medical Journal," May, 1866. 
 
74 APHASIA, OR LOSS OF SPEECH. 
 
 impulses for the articulation of language cannot be 
 transmitted. The essential morbid change is, therefore, 
 motor, and not mental* 
 
 In the "Journal of Mental Science" for April, 1872, a 
 case is recorded by Dr. J. Batty-Tuke and Dr. John 
 Frazer, in which the posterior half of the third left 
 frontal convolution was completely destroyed, both as 
 regards the grey and white matter, and the only defect 
 in language was partial verbal amnesia. The other 
 points of interest were stated to be the laying bare of the 
 extra-ventricular nucleus of the corpus striatum without 
 its being morbidly affected, and the absence of right 
 hemiplegia. 
 
 Now, this observation has an extremely important 
 bearing upon a disputed point in the pathology of 
 aphasia, and it has been cited by the authors as a com- 
 plete testimony to the erroneous nature of Broca's 
 convolutional theory. As, however, the correctness of 
 this deduction has been challenged by a distinguished 
 neurological authority, it cannot be otherwise than useful 
 to glance at the leading features of a case which has 
 given rise to so much discussion. 
 
 M. R., aged 54, a single woman, was received into the 
 Fife and Kinross Asylum on December 14th, 1868, 
 symptoms of insanity having developed themselves only 
 four weeks previous to her admission. The history of 
 the case is that of an apoplectic seizure eleven years 
 previous to the above date. Whilst working in a field, 
 
 * "The Pathology of Aphasia," "Journal of Mental Science," January, 
 1867. 
 
SCOTTISH WRITERS. 75 
 
 she suddenly fell down and became unconscious, remain- 
 ing insensible for some weeks. There seems to have 
 been no paralysis, but complete speechlessness existed for 
 some time ; from this, however, she completely recovered, 
 and, previous to her admission, she had become rather 
 talkative. During the whole period of her residence in 
 the asylum, two peculiarities in her speech were ob- 
 served — a thickness of articulation resembling that of 
 general paralysis, and a hesitancy when about to name 
 anything, which was most marked when she came to a 
 noun. Latterly, she could not recall even the common- 
 est terms, and periphrases or gestures were used to 
 indicate her meaning. She was always relieved and 
 pleased if the words were supplied to her, when she 
 invariably repeated them. For example, she would say, 
 
 "Give me a glass of ." If asked if it was "water," 
 
 she said, " No." " Wine ? " " No." " Whisky ? " " Yes, 
 whisky." Never did she hesitate to articulate the word 
 if she heard it. She had a peculiar stoop in her walk, 
 with constant pain, increased on pressure, at the third 
 and fourth dorsal vertebrae ; she became paraplegic two 
 months before her death, which occurred three years 
 after her admission. 
 
 Autopsy. Calvarium very dense and thick, tables thickened, 
 diploe thin, membranes healthy, except some old adhesions on the 
 left side, at the anterior part. Brain appeared to be slightly 
 shrunken, but the amount of serum which escaped (i| ounces) was 
 not sufficient to indicate general atrophy. On stripping off the 
 dura mater on the left side, some slight adhesions were found 
 between the layers of the arachnoid ; these were easily detached, 
 and exposed an excavation of the brain substance at the postero- 
 infero-external part of the left frontal lobe. Its outline was 
 irregular, its cavity filled with serum, and narrow white bands 
 sprang from its sides. On emptying the cavity, its dimensions were 
 
j6 APHASIA, OR LOSS OF SPEECH. 
 
 found to be as follows : — In its long axis, from before backwards, 
 parallel to the fissure of Sylvius, two and a quarter inches 
 obliquely ; vertically one and three-sixteenths of an inch ; in its 
 deepest part it was three-quarters of an inch, but generally only 
 half-an-inch. This lesion had destroyed posteriorly the inferior 
 fourth of the ascending parietal convolution, leaving a small pos- 
 terior portion of the knuckle in which this gyrus ends ; the inferior 
 third of the ascending frontal, the inferior margin of the second 
 frontal, and the posterior half of the third frontal convolution. 
 At the inferior margin there was a narrow ridge of slight eminence, 
 which might have been the remains of the inferior border of the third 
 frontal ; with this exception, the destruction of the posterior half of 
 this convolution was complete, both as regards its grey and white 
 matter. The bottom of the cavity seemed to be an anatomical 
 limitation, as it was smooth, rounded, and presented no evidence 
 of morbid action ; incision proved it to be the extra-ventricular 
 nucleus of the corpus striatum. Microscopical examination of the 
 grey matter taken from the orbital lobule, and from the various 
 superior gyri, showed few nerve cells, and these few had undergone 
 almost complete fatty or fuscous degeneration. There was slight 
 dilatation of the aorta and a few atheromatous patches on the 
 valves, which were thin, and the mitral orifice was small. 
 
 As I before stated, this case has provoked a good deal 
 of adverse criticism, and Dr. Wilks has expressed the 
 opinion that it by no means warrants the inference which 
 Drs. Tuke and Frazer have drawn from it ; indeed, on 
 the contrary, he regards it as a case highly corroborative 
 of the views of Broca and his followers.* 
 
 I refrain from personally commenting upon this con- 
 troversial case at this stage of my treatise, but I shall 
 have occasion to refer to it later on. I will merely point 
 out that the inference to be drawn from it depends upon 
 what is understood by the word Aphasia ; the patient 
 evidently understood what was said to her, and also 
 
 * "Journal of Mental Science," July, 1872, p. 307. 
 
SCOTTISH WRITERS. 7J 
 
 what she read, but she was unable to express herself in 
 articulate language until the word was suggested to her, 
 when she instantly recognised it, and repeated it. 
 According to the broad definition which I have adopted 
 in this work, it is clearly a typical instance of one of the 
 various morbid conditions that I have included under 
 the generic term of Aphasia. 
 
 One of the most important cases bearing upon the 
 question of the localisation of the faculty of speech, has 
 been published by Dr. Foulis, of Glasgow. 
 
 A house-painter, aged 64, was admitted into the Royal 
 Infirmary of Glasgow, under the care of Dr. Scott Orr, 
 on August 9th, 1878, for cardiac dropsy, which proved 
 fatal at the end of two months. The history of the 
 clinical symptoms is not given in detail, as it is stated 
 that they in no way varied from those usual in such cases, 
 and were not therefore of special interest. Dr. Foulis, 
 however, states that there was not the least symptom 
 of any defect in the speech of the patient, who could 
 talk with perfect fluency and correctness ; nothing was 
 noticed which in any way pointed to cerebral mischief, 
 except a tendency when lying quiet in bed to carry on 
 imaginary narratives in a casual sort of way, and to refer 
 to events as presently occurring, which had no existence 
 except in his imagination. Otherwise, he was intelligent 
 and quiet, and, when spoken to, he would give correct 
 and sensible replies. After death, Dr. Foulis noted the 
 following morbid appearances: — 
 
 Necropsy. — The body was badly nourished ; the legs 
 were dropsical. Twenty-two pints of slightly turbid 
 fluid, with flakes of lymph floating in it, were found in 
 ,the abdominal cavity ; a quantity of a similar fluid in 
 
78 EXTENSIVE LESION OF THE THIRD LEFT 
 
 the right pleural sac, along with a web-shaped layer of 
 recent lymph ; and a little clear serum in the left pleural 
 sac. The heart was dilated and enlarged, weighing 
 20 oz. ; there were a few firm vegetations on the mitral 
 valve, the other valves were healthy. The aorta was 
 wide and slightly tortuous, its lining membrane was 
 thickened and atheromatous. The right lung was much 
 compressed, its pleural surface was like chamois-leather 
 in appearance, its tissue was subcrepitant and still 
 capable of floating in water. The left lung was rather 
 ©edematous. The lining of the air-tubes generally was 
 reddened. The liver was commencing to become 
 cirrhotic ; in the gall-bladder were inspissated bile and 
 several scores of calculi, some white and facetted, 
 others black and mulberry-shaped. The gall-ducts 
 and the portal vessels were patent. The kidneys 
 were both in advanced cirrhosis. The splenic capsule 
 was thickened and white. The urinary bladder was 
 slightly hypertrophied. The gullet and intestines were 
 normal. There were a few patches of red mottling in 
 the mucous membrane of the stomach, as if from puncti- 
 form haemorrhage, but no ulceration. The spine had a 
 strongly marked dorsal kiphosis (not angular), and a 
 lateral curve convex to the right side in the upper dorsal 
 region ; there were irregular exostoses over the bodies 
 of the dorso-lumbar vertebrae. The skull and dura 
 mater were healthy ; the arteries at the base of the brain 
 were atheromatous. The third left frontal convolution 
 was almost entirely destroyed, along with two-thirds of 
 the island of Reil ; over this area, the pia mater was 
 disorganised and converted into a non-vascular, trans- 
 parent, shreddy membrane, adherent to the pulpy-brown 
 surface of the irregular excavation where the brain- 
 
FRONTAL CONVOLUTION WITHOUT APHASIA. 79 
 
 substance was missing; the arachnoid was raised at this 
 spot by clear fluid which filled the gap, and gelatinous- 
 looking bands ran across the fluid between the arachnoid 
 and the pia mater. The brain and its membranes other- 
 wise seemed to be free from disease. 
 
 Here then we have a description by a pathologist of 
 eminence, of an anatomically demonstrated lesion of the 
 third left frontal convolution, without the functional dis- 
 turbance said to be connected with disease in that 
 locality. The patient was right-handed, there was no 
 hemiplegia, and aphasia was not at any time a feature 
 in the case, although the destruction of the third left 
 frontal convolution was so complete as to abolish any 
 function which it may have exercised. Dr. Foulis, in 
 commenting upon the symptoms observed during life, 
 and the pathological appearances noted after death, 
 maintains that the theory of Broca is rendered untenable 
 by the consideration of this case.* 
 
 Medical science is indebted to the physicians of the 
 " sister island'' for much valuable information communi- 
 cated by them in reference to cerebral loss of speech. 
 
 In the Dublin Quarterly Journal for February, 185 1, 
 Graves has recorded a most singular instance of amnesic 
 aphasia, limited to substantives and proper names. The 
 subject of it was a Wicklow farmer, fifty years of age, 
 who, after an attack of hemiplegia, was affected with an 
 
 * "British Medical Journal," March 15th, 1879, p. 383. Dr. Foulis' 
 description was illustrated by an engraving, by which it was seen that the 
 only part of the third left frontal convolution which remained was a thin 
 shred at the extreme posterior end, and that the island of Reil also was to 
 a large extent excavated. 
 
 F 
 
80 APHASIA, OR LOSS OF SPEECH. 
 
 incapacity to employ nouns and proper names, he being 
 able in other respects to express himself well. This 
 defect was accompanied by the following singular 
 peculiarity : that he perfectly recollected the initial letter 
 of every substantive or proper name for which he had 
 occasion in his conversation, though he could not recall 
 to his memory the word itself. He consequently made 
 for himself a little pocket dictionary of the words in 
 most general use, including the proper names of his 
 children, servants, and acquaintances, and during a 
 conversation he would look in his dictionary till he 
 found the word he wanted, keeping his finger and eye 
 fixed on the word until he had finished the sentence, 
 but the moment the book was closed, the word passed 
 out of his memory and could not be recalled, although 
 he recollected its initial, and could refer to it again in 
 his dictionary when necessary. 
 
 The learned Dublin professor, in his clinical lectures, 
 has also recorded two most interesting cases, where loss 
 of speech was at first the only morbid symptom, but 
 he does not dwell on the pathology of this singular 
 affection ; and, strange to say, although the cases re- 
 corded are typical instances of aphasia, he seems to 
 imply that in loss of speech the defect may be in the 
 glottis rather than be the result of cerebral lesion!* 
 
 In the same Journal for February, 1865, is a valuable 
 paper by Dr. Banks, in which he mentions the following 
 very curious case : — 
 
 A gentleman, aged 54, was eight years since attacked 
 with paralysis of the right side and aphasia. At first the 
 loss of speech was complete, but after twelve days he 
 
 * "Clinical Medicine," p. 433. 
 
IRISH WRITERS. 8 1 
 
 could say a few words. Before his attack lie was a ripe 
 scholar, and had taken much pleasure in reading the 
 best classical authors ; but when his stock of words had 
 increased so as to enable him to converse a little on 
 ordinary subjects, it was observed that his memory had 
 quite failed him with respect to Greek and Latin. For 
 six years he continued without improving to any con- 
 siderable extent, but still he was gradually acquiring 
 new words. For the next two years his progress was 
 more rapid ; he laboured hard, and almost learned over 
 again all that he had forgotten, so as to be able to read 
 his old favourite classical authors once more. The 
 accomplished Trinity College Professor adduces this 
 case to prove that, even in aphasia with paralysis, the 
 mind may remain unclouded, and the power of speech, 
 even after years, may be re-established. 
 
 At the annual meeting of the British Medical Associa- 
 tion held at Dublin in August, 1867, I had the pleasure 
 of reading a paper on the " Localisation of the Faculty 
 of Speech," after which an interesting discussion took 
 place, in which Professor Gairdner, Drs. Lyons, Hayden, 
 Lalor, Gibson, &c, took a part, and some extraordinary 
 instances of the sudden loss of speech, and of the in- 
 tellectual results that followed, were mentioned. 
 
 During my visit to Dublin, Dr. Lyons kindly called my 
 attention at the Hardwicke Hospital to an extremely 
 interesting case of aphasia occurring as a complication 
 of cerebro-spinal arachnitis. 
 
 The subject of it, John Oyden, a delicate boy, aged 
 eleven years, was admitted into the hospital on May 
 30th, being reported three days ill. His symptoms were 
 those of well-marked cerebro-spinal arachnitis, of pure 
 
82 APHASIA, OR LOSS OF SPEECH. 
 
 type, and intense degree. The face was flushed, the 
 pupils were dilated, and the patient complained of much 
 acute pain in the head and back of the neck, which 
 extended down the spine for a considerable distance. On 
 June 3rd the usual eruption made its appearance. On 
 June 25th the patient became affected with aphasia, the 
 right side being at the same time paralysed. He re- 
 mained in this state for many days ; the only words he 
 was able to utter were "day, day," which was his answer 
 to all inquiries. In the beginning of July he rallied a 
 good deal and regained the power of speech, but on 
 August 27th he again became the subject of aphasia, in 
 which state he died.* 
 
 Dr. Popham, of Cork, in a very elaborate paper in the 
 Dublin Quarterly Journal, mentions the following case, 
 which he says bears on M. Broca's views. 
 
 Mary Murphy, aged sixty, was admitted to the Union 
 Hospital with right hemiplegia and impaired speech. 
 The memory of words was very defective, and the 
 articulation confused ; for " Thank you, sir," she said 
 " Fancy sell ; " and being asked what her husband, a 
 pedlar, sold, she replied " procties and pudding pans," 
 which Dr. Popham found out meant "brooches and 
 bosom pins." She eventually died of pneumonia, when 
 the following appearances were observed at the post- 
 mortem examination : — The heart was covered with fat, 
 the mitral orifice was narrow, its margins ossified, and 
 there were some vegetations on the auricular surface. 
 There was considerable effusion under the arachnoid 
 
 * The above very meagre report of this remarkable case is taken from 
 the "British Medical Journal," of September 28th, 1867. 
 
AMERICAN WRITERS. 83 
 
 membrane. On careful examination of the left hemi- 
 sphere, the convolution of Broca was softer in consistence 
 than the neighbouring parts, and the remains of an 
 apoplectic cyst, of the size of an almond, and empty, 
 was situated close to the anterior third of the corpus 
 striatum, and running parallel to its course. 
 
 I now arrive at the consideration of the labours of 
 our American cousins, beginning with Dr. S. Jackson, 
 of Pennsylvania, who records the following curious case. 
 
 The Rev. Mr. , aet. 48, endowed with intellectual 
 
 powers of a high order, of a sanguine temperament, 
 with latterly a strong tendency to obesity, having 
 exposed himself to the influence of the night air, re- 
 ceived a check to the cutaneous perspiration. The next 
 morning he awoke with a headache, and when a friend 
 went into his room to inquire after his health, he was 
 
 surprised to find Mr. R could not answer his 
 
 questions. Dr. Jackson having been summoned, found 
 the patient in full possession of his senses, but incapable 
 of uttering a word ; the tongue was not paralysed, but 
 could be moved in every direction ; all questions were 
 perfectly comprehended and answered by signs, and 
 it could be plainly seen by the smile on the countenance, 
 after many ineffectual attempts to express his ideas, 
 that he was himself surprised, and somewhat amused at 
 his peculiar situation. The face was flushed, the pulse 
 full and somewhat slow, and to the inquiries if he 
 suffered pain in the head, he pointed to his forehead as 
 its seat. When furnished with pen and paper, he 
 attempted to convey his meaning, but he could not 
 recall words, and only wrote an unintelligible phrase, 
 
84 APHASIA, OR LOSS OF SPEECH. 
 
 " Didoes doe the doe." Forty ounces of blood were 
 drawn from the arm and before the operation was 
 completed speech was restored, though a difficulty con- 
 tinued as to the names of things, which could not be 
 recalled. The loss of speech appearing to recur in 
 fifteen minutes, ten ounces more blood were abstracted, 
 and sinapisms supplied to the arms and thighs alter- 
 nately. These means were speedily effectual, and no 
 further return of the affection took place. 
 
 Dr. Jackson, in analysing this case, calls attention to 
 the following facts. Firstly, sudden suppression of the 
 cutaneous transpiration, succeeded by cerebral irritation 
 and determination of blood to the brain : secondly, 
 frontal pain immediately over the eye : thirdly, perfect 
 integrity of the sensations and voluntary movements : 
 fourthly, the general operations of the intellect undis- 
 turbed ; ideas formed, combined, and compared ; those 
 of events, of time, recalled without difficulty : fifthly, 
 loss of language or of the faculty of conveying ideas by 
 words though not by signs ; this defect not being con- 
 fined to spoken language, but extending to written lan- 
 guage also.* 
 
 Dr. Hun, of Albany, mentions the case of a blacksmith, 
 a2t. 35, who, before the present attack, could read and 
 write with facility, but who had been labouring for 
 several years under a disease of the heart. After a long 
 walk in the sun, he was seized in the evening with 
 symptoms of cerebral congestion, remaining in a state of 
 stupor for several days. After a few days he began to 
 recover from this condition, and understood what was 
 
 * "American Journal of Medical Sciences," February, 1829, p. 272. 
 
AMERICAN WRITERS. 85 
 
 said, but it was observed that he had great difficulty in 
 expressing himself in words, and for the most part could 
 only make his wants known by signs. There was no 
 paralysis of the tongue, which he could move in all 
 directions. He knew the meaning of words spoken 
 before him, but could not recall those needed to express 
 himself, nor could he repeat words when he heard them 
 pronounced ; he was conscious of the difficulty under 
 which he was labouring, and seemed surprised and dis- 
 tressed at it. If Dr. Hun pronounced the word he 
 needed, he seemed pleased, and would say, "Yes, that is 
 it," but was unable to repeat the words after him. After 
 fruitless attempts to repeat a word, if Dr. Hun wrote it 
 for him, he then would begin to spell it letter by letter, 
 and, after a few trials, was able to pronounce it ; if the 
 writing were now taken from him, he could no longer 
 pronounce the word ; but after long study of the written 
 word, and frequent repetition, he would learn it so as to 
 retain it and afterwards use it. He kept a slate, on 
 which the words he required most were written, and to 
 this he referred when he wished to express himself. He 
 gradually learned these words and extended his vocabu- 
 lary, so that after a time he was able to dispense with 
 his slate. He could read tolerably well from a printed 
 book, but hesitated about some words ; when he was 
 unable to pronounce a word, he was also unable to write 
 it until he had seen it written ; and then he could learn 
 to write as he learned to pronounce, by repeated trials. 
 At the end of six months, by continually learning new 
 words, he could make himself understood pretty well ; 
 often, however, employing circumlocution when he could 
 not recall the proper word, somewhat as if he were 
 speaking a foreign language, imperfectly learned. 
 
86 INTERMITTENT LOSS OF SPEECH ALTERNATING 
 
 Dr. Hun infers, from what precedes, that there is a 
 portion of the brain connected with language or the 
 memory of words, as distinct from the memory of 
 things and events ; and that there is another portion on 
 which depends the co-ordination of the movements of 
 articulation. It will be observed that in the above case, 
 the impression made on the acoustic nerve was not 
 sufficient for rendering the articulation of the word 
 possible, but that it was necessary that an impression 
 should be made upon the optic nerve. Dr. Hun asks 
 whether this can be explained by the supposition of a 
 more intimate connection between vision and articulation, 
 or by the fact that the impression on the acoustic nerve 
 is transient, whilst that on the optic is more permanent* 
 
 The same author has also recorded a most remarkable 
 case of hysterical aphasia in a married man, aged 43, 
 who followed the occupation of a livery-stable keeper. 
 The clinical history is given by Dr. Hun with great 
 detail, but it contains so many points of interest that I 
 transcribe it in full. 
 
 In December, 1863, while at work in his stable about 
 4 p.m., he felt some nausea ; he walked home, and during 
 the evening lost his speech ; an hour later he lost his 
 sight and hearing, but retained his consciousness ; at the 
 end of another hour he had several severe convulsions. 
 After the convulsions he was perfectly conscious, but 
 did not regain his sight, hearing, or speech for twenty- 
 four hours. 
 
 Six months after, he had another attack which was not 
 preceded by nausea ; he lost his speech, sight, and 
 hearing at 6 p.m. ; at nine he commenced to have con- 
 
 * "American Journal of Insanity," April, 1851. 
 
WITH LOSS OF HEARING AND OF SIGHT. 87 
 
 vulsions, which lasted until 6 a.m. There was no uncon- 
 sciousness either during or after the fits. His sight 
 returned the next day, but he remained speechless and 
 deaf for forty-eight hours. Three weeks later he had a 
 similar attack. 
 
 He now continued well till April 20th, 1865, when he 
 was startled and excited by the discharge of a cannon, 
 causing the horse he was driving to become difficult to 
 manage. Soon after this he had a headache, and in a 
 few hours became speechless, blind, and deaf, but re- 
 tained his consciousness. He wrote upon a slate what he 
 wished to communicate, and when his hand holding the 
 pencil was guided by that of another person, he under- 
 stood what was written ; he could open his mouth and 
 move his tongue freely, but swallowed with some diffi- 
 culty ; he made signs as if he felt some obstruction in 
 his throat ; the pulse was slow and regular. In the 
 course of the night convulsions came on, and during 
 these his body and limbs stiffened, his head was thrown 
 backwards as in a tetanic spasm, but the respiration was 
 not interrupted, the face was not flushed, and he did not 
 bite his tongue. The convulsive attack lasted about five 
 minutes, when the rigidity suddenly relaxed, and the 
 patient stated that he suffered severely during the spasm. 
 At the end of twelve hours, his speech, sight, and hear- 
 ing suddenly returned, and he regained his usual good 
 health. 
 
 In October, 1865, he had another attack ; this time he 
 lost his speech and hearing, but retained his sight. He 
 went about town, communicating with those he met by 
 means of his slate and pencil. This continued for 
 several days, when, after some excitement, he lost his 
 sight and had several severe convulsions like those 
 
88 APHASIA, OR LOSS OF SPEECH. 
 
 described above. After the convulsions he regained his 
 speech, sight, and hearing, and felt perfectly well. 
 
 On March 14th, 1867, at 5 p.m., he complained of 
 headache and nausea, and an hour later he was seized 
 with convulsions, during which he lost his speech, sight, 
 and hearing. Dr. Hun had the opportunity of witnessing 
 one of these convulsions, which began as he entered the 
 house. It commenced with a slight twitching of the 
 muscles of the face and shoulders, and then suddenly a 
 strong tetanic spasm (opisthotonos) ; all the muscles 
 of his body were rigid. This lasted for about fifteen 
 minutes, when, in an instant of time, the whole body 
 was drawn in the opposite direction (emprosthotonos), 
 and was as rigid as it had been before; so suddenly 
 and powerfully did the change take place, that one 
 of the four men holding him was thrown to the floor. 
 After about twenty seconds the muscles relaxed, and 
 he remained quiet for a few minutes, during which 
 time he made signs for the slate, and wrote that he had 
 " a burning pain in his side, and a severe headache." 
 After this interval of repose, his left arm and leg were 
 strongly flexed, and his head and body drawn to the left 
 side, while the muscles of the right side remained re- 
 laxed. Dr. Hun then, by guiding his hand and holding 
 his pencil, made him write the word "Yes," which he 
 understood, although he was speechless, blind, and deaf, 
 for he immediately wrote, " I am suffering great pain; 
 can you not help me?" He had already taken two 
 doses of chloroform and ether, and Dr. Hun gave him 
 a hypodermic injection of morphia in the left arm, but 
 he did not seem to feel the needle penetrate the skin, 
 nor did he show any signs of pain when the left arm was 
 pinched ; upon pinching the right arm, he drew it away ; 
 
AMERICAN WRITERS. 89 
 
 during all this time his pulse was slow, regular, and 
 strong ; the next morning he was able to see, but was 
 unable to speak or hear. 
 
 March 2 1st. Dr. Hun met him walking about the 
 streets, communicating with others by means of his slate 
 and pencil ; he could neither speak nor hear. On the 
 previous day his hearing had returned to him without 
 any convulsion or warning of any kind; he retained 
 this faculty for a few hours and then went to sleep, 
 and when he awoke, he was again deaf as well as 
 speechless. 
 
 March 26th. He had four severe convulsions, after 
 which he still remained speechless and deaf until June 
 6th, when, after a severe headache, he recovered his voice 
 for fifteen or twenty minutes, but could not hear. 
 
 June 8th. While in New York upon business early in 
 the day, he was attacked with headache and with twitch- 
 ing of the muscles, but no regular convulsions ; in the 
 evening he began to talk, and half an hour afterwards his 
 hearing was restored, but at the same time he became 
 blind ! The next morning, when he awoke, he felt 
 perfectly well, and was able to speak, see, and hear. He 
 told Dr. Hun that the day after an attack he always 
 passed a great deal more urine than usual, and that he 
 had an idea that the obstruction he experienced in his 
 throat, was due to the attempts made by a tape-worm 
 to get out of his stomach. 
 
 He now remained well until November 16th, when he 
 had a dull headache during the morning, which increased 
 in severity until 6 p.m. ; he then had convulsions, with 
 loss of speech, sight, and hearing ; at eleven o'clock the 
 convulsions ceased, and his sight returned, but he re- 
 mained deaf and speechless until November 29th, when 
 
90 APHASIA, OR LOSS OF SPEECH. 
 
 he had headache, and a slight twitching of the muscles 
 during the morning ; at 6 p.m. he had convulsions 
 lasting two hours, after which his speech and hearing 
 again returned. Since that time he continued perfectly- 
 well, and was able to attend to his business as usual. 
 
 Dr. Hun, in commenting upon the exceptional features 
 of this most interesting case, characterises it as one of 
 hysteria, basing this opinion upon the following analysis 
 of the chief symptoms observed: — 1st. He retained his 
 consciousness during the attacks. 2nd. No spasm of 
 the glottis, his face remaining pale. 3rd. He did not 
 bite his tongue. 4th. Globus hystericus and dysphagia. 
 5th. Increased urinary secretion after the attacks. 6th. 
 Localised analgesia (as shown when the needle of the 
 hypodermic syringe was introduced into the left arm) 
 without anaesthesia (as shown by his being able to hold 
 his slate and pencil with both hands). 7th. The restora- 
 tion of speech, sight, or hearing seemed always to be 
 accompanied by convulsions.* 
 
 Professor Bigelow, of Boston, has reported a remark- 
 able case which occurred in the practice of Dr. Harlow 
 of Vermont, of very extensive injury to the brain, with- 
 out loss of the power of articulate language. 
 
 On September 13th, 1848, the foreman of a mine, a 
 young and healthy man, was engaged, with a tamping- 
 iron in his hand, in ramming down a charge of powder 
 in a rock to be blasted. The tamping-iron was an iron 
 bar, pointed at one end, three feet seven inches in 
 length, one and a quarter inches in diameter, and weigh- 
 ing thirteen pounds four ounces. Thinking that the 
 
 * "The Quarterly Journal of Psychological Medicine and Medical 
 Jurisprudence," January, 1868, p. 1 19. 
 
AMERICAN WRITERS. 9 1 
 
 blast had been properly covered with sand, he struck it 
 a blow with the round end of the bar, when a spark 
 flying from the rock ignited the uncovered powder, pro- 
 ducing an explosion which drove the tamping-iron 
 completely through his skull. The pointed extremity 
 entered in at the angle of the lower jaw, on the left side, 
 passing upward and a little inward, emerging in the 
 neighbourhood of the anterior fontanelle junction, thus 
 passing quite through his head. In a few minutes he 
 recovered consciousness, was put into a cart and con- 
 veyed to his residence, conversing on his way home ; he 
 then was able to walk into his house. 
 
 During the progress of the case the patient retained 
 full command of speech, and though at times drowsy, 
 was always rational. Recovery was perfect in about 
 eleven weeks, but the sight of the left eye was lost. It 
 is stated that he became very profane, never having been 
 so before the accident. He lived twelve years and a 
 half after this formidable injury, when, after having had 
 several convulsions, he died. 
 
 Dr. Austin Flint, in giving an account of six cases 
 which had fallen under his observation, expresses his 
 strong dissent from the doctrine of the localisation of 
 the faculty of speech in the left hemisphere, and he 
 thinks that anatomical researches may show why lesion 
 of speech is a more constant accompaniment of dextral 
 than of sinistral paralysis. 
 
 In the American " Quarterly Journal of Psychological 
 Medicine" for January, 1868, is an essay by Dr. 
 E. C. Seguin, in which he gives a report of fifty cases of 
 aphasia that have been treated at the New York 
 
92 APHASIA, OR LOSS OF SPEECH. 
 
 Hospital. Four only were observed by the writer, and 
 he adds that the remaining forty-^ix cases were recorded 
 before aphasia was recognised, and were therefore very 
 imperfectly noted, and consequently open to challenge. 
 
 With the view of establishing the frequency of aphasia 
 with lesions of different parts of the brain, Dr. Seguin 
 has collected 556 cases from various sources, with the 
 following comparative results : — 
 
 PARTS OF ENCEPHALON DAMAGED IN APHASIA CASES. 
 
 Third frontal convolution on the left side 19 cases. 
 
 right side I 
 
 Anterior lobe of left side - - 514 cases. 
 
 „ „ right side - - . 2 „ 
 
 Lateral ventricles distended - - 2 „ 
 
 Corpora striata - - - - 6 ,, 
 
 Middle lobes - - - -■ 3 ». 
 
 Posterior lobes - - • - 4 ,, 
 
 General softening of the hemisphere - 2 „ 
 Cases of aphasia without lesion of brain 
 
 substance - - - 3 » 
 
 In order to compare the frequency of loss of speech 
 coinciding with right and left hemiplegia respectively, 
 Dr. Seguin has collected 260 cases of hemiplegia with 
 concurrent aphasia; from which he calculates that the 
 number of cases accompanied by left hemiplegia as 
 compared with those in which dextral paralysis is 
 present, is as 243 to 17, or 14.3 to I. 
 
 Dr. Wilbur, the Superintendent of the State Asylum 
 for Idiots, at Syracuse, N. Y., has written an extremely 
 interesting pamphlet, in which he treats the aphasic 
 
DEFECTS OF SPEECH INT IDIOTS. 93 
 
 question, as illustrated by his own experience amongst 
 idiots. The clinical history is concisely given of a series 
 of cases that have fallen under Dr. Wilbur's observation 
 during a period of twenty years, and in which there was 
 complete or partial absence of the power of articulate 
 language. 
 
 Of the 443 idiots he has had under his care, 121 were 
 entirely mute — could not or did not utter a single word ; 
 64 could say only a word or two; in 163 there was 
 imperfect speech ; and 95 are described in the register 
 as able to speak. In these last cases, he adds, the 
 ability to speak was commensurate, in some degree, with 
 the intelligence ; but, in a large proportion of them, 
 there was great backwardness in learning to speak. 
 
 A large proportion, perhaps seventy-five per cent., of 
 Dr. Wilbur's cases were congenital ; the remainder had 
 their faculties impaired by disease in infancy or early 
 childhood. In these latter, when there was loss of 
 speech, it occurred in some instances gradually, but 
 more commonly instantly. He adds that intelligence, 
 and speech or expression, have certainly not always 
 gone with an equal step. 
 
 Dr. Wilbur gives the clinical history of his patients, 
 with special reference to their loquelar defect ; it is, 
 however, much to be regretted that in no instance is the 
 case completed by a post-mortem examination. I have 
 selected the following case from Dr. Wilbur's collection, 
 as tending to illustrate how much may be done towards 
 partially developing speech in the idiot: — ■ 
 
 A boy, eight years old, good-looking and well-formed, 
 came under observation, idiocy having supervened in 
 infancy. He looked intelligent, was very gentle and 
 obedient ; he understood any simple language addressed 
 
94 APPIASrA, OR LOSS OF SPEECH. 
 
 to him, or spoken in his hearing ; he could repeat the 
 sentences he heard or the question spoken, but could 
 originate nothing in the form of speech, under any cir- 
 cumstances. The control over his vocal organs was 
 complete ; he spoke quite distinctly, and with appropriate 
 emphasis. He soon began to learn rapidly the exercises 
 given to him, but the power or disposition to originate 
 speech, even within the range of his wants or his 
 affections, was wanting. The failure in the power of 
 speech seemed to be in the absence of the proper volition. 
 In this case, the defect was overcome at last, through 
 reading exercises, and eventually the boy could speak 
 spontaneously. 
 
 It may be said that imperfection of speech in the 
 idiot is so intimately connected with a general want of 
 intelligence, that it bears but little analogy to loss of 
 speech as occurring in individuals of full intellectual 
 capacity. Whilst to some extent admitting this, when 
 I consider Dr. Wilbur's great success in developing the 
 power of expression in the idiot, I cannot but think that 
 if other physicians with similar opportunities to his 
 would follow his example and place on record their own 
 experience, a lasting benefit would be rendered to the 
 cause of psychological science, and the solution of the 
 particular question we are now discussing would be 
 materially aided. 
 
 One of the most important American contributions to 
 the literature of aphasia is that of Dr. Hammond, so 
 well known for his able and original writings on psychia- 
 trical subjects, and for his observations and researches 
 in the normal and pathological anatomy and histology 
 of the nervous centres. In his classical work on Diseases 
 
AMERICAN WRITERS. 95 
 
 of the Nervous System, he devotes a chapter to defects 
 of speech, which, whilst constituting an accurate record 
 of the labours of others, is enriched by the matured 
 experience of the writer. From the cases observed by 
 Dr. Hammond, I have selected the following as a very 
 remarkable and instructive one. 
 
 A retired military officer consulted Dr. Hammond in 
 the autumn of 1869 for paralysis, vertigo, and slight 
 difficulty of speaking, from which he had suffered for 
 some months. Several years previously he had been 
 under medical care for acute rheumatism, with cardiac 
 complications. The history of the case pointed strongly 
 to embolism, and, as the paralysis involved the right 
 side, Dr. Hammond diagnosticated a previous attack of 
 embolism of the left middle cerebral artery. The diffi- 
 culty of speech was slight ; there were both amnesic and 
 ataxic aphasia. 
 
 Under the treatment employed he improved very 
 much in the ability to walk, to use his arm, and to 
 speak, so much so that his friends considered him better 
 than he had been for several years. About six weeks 
 after he came under Dr. Hammond's charge, he had 
 another attack. This_ time the left side was paralysed, 
 and there was no difficulty of speech. Galvanism was 
 employed as before, and he recovered sufficiently to go 
 to Washington city. While there he had a third attack, 
 characterised by right hemiplegia and aphasia. He 
 soon regained his power of speech, and shortly afterward 
 had a further attack, involving the left side, and un- 
 attended by aphasia. He soon recovered from this, and 
 returned to New York, when Professor Flint was re- 
 quested to see him in consultation, with the special view 
 of examining the heart, when no abnormal sounds were 
 
 G 
 
g6 APHASIA, OR LOSS OF SPEECH. 
 
 detected. While in New York he had two other attacks, 
 during both of which he was delirious ; both also were 
 characterised by hemiplegia ; that of the left side was 
 unaccompanied by aberrations of language, whilst that 
 of the right side was attended with ataxic and amnesic 
 aphasia ; he forgot the names of the most ordinary 
 things, and there were many words that he could not 
 articulate at all — thus when he wanted a fan, he called it 
 " a large flat thing to make wind with ; " he also forgot 
 Dr. Hammond's name. He afterwards greatly improved, 
 but had other attacks, and finally died in the autumn of 
 1 87 1, presumably of cerebral softening. 
 
 It will be observed that the interesting features of this 
 case were the concurrence of hemiplegia and ataxic and 
 amnesic aphasia, and the striking fact that there was 
 no aphasia when the paralysis involved the left side. 
 According to Dr. Hammond's views, this patient had 
 repeated attacks of cerebral embolism. When the em- 
 bolism lodged in the left middle cerebral artery, there 
 was aphasia accompanied by right hemiplegia ; when the 
 embolus obstructed the right middle cerebral artery, 
 here was left hemiplegia, but no aphasia. 
 
 After a full consideration of all the facts and argu- 
 ments that have been urged on all sides of the question, 
 Dr. Hammond rejects the restricted location of MM. 
 Dax, and the still more limited area contended for by 
 M. Broca, in reference to the seat of speech, and 
 enumerates several interesting cases to substantiate the 
 following conclusions : — 
 
 1st. That the organ of language is situated in both 
 hemispheres, and in that part which is nourished by the 
 middle cerebral artery. 
 
 2nd. That while the more frequent occurrence of right 
 
AMERICAN WRITERS. 97 
 
 hemiplegia, in connection with aphasia, is in great part 
 the result of the anatomical arrangement of the arteries 
 which favours embolism on that side, there is strong 
 evidence to show that the left side of the brain is more 
 intimately connected with the faculty of speech than 
 the right. 
 
 During the last few years a considerable number of 
 valuable psychological communications illustrating the 
 various forms of impairment of the faculty of articulate 
 language have emanated from the American press, 
 amongst which I would especially mention those of 
 Dr. E. C. Mann and Dr. Morton Prince, both of which 
 bear evidence of much original thought and careful 
 research. 
 
 Since the publication of my first edition, an immense 
 number of important contributions to the pathology of 
 aphasia have come under my notice, and I could extend 
 this bibliographical record ad infinitum, but the wide 
 range embraced by the subject I am treating compels 
 me to limit this portion of my work to the smallest 
 possible space ; I propose, however, when dealing with 
 the question of the causes, varieties, and treatment of 
 aphasia, to illustrate my remarks by reference to various 
 other interesting cases that have fallen under my 
 observation, and which could not be included in this 
 bibliographical sketch. 
 
CHAPTER IV. 
 
 author's own clinical experience. 
 
 " Segniiis irritant animos demissa per aurem, 
 Quam quse sunt oculis subjecta fidelibus, et quse 
 Ipse sibi tradit spectator." 
 
 HAVING in the preceding pages endeavoured critically 
 to review the question of the localisation of the faculty 
 of speech, as illustrated by the labours of the French, 
 Dutch, and German pathologists, as well as by those of 
 the different branches of the Anglo-Saxon race, I now 
 proceed to place on record a certain number of cases 
 which have been observed by myself, and in several of 
 which the clinical history was completed by a careful 
 post-mortem examination. 
 
 In some instances it may be thought that I have 
 described the clinical history with too much minuteness, 
 and with a fastidious attention to apparently unim- 
 portant details ; but the question we are now considering 
 is involved in so much obscurity, that it seems to me 
 that it is only by carefully studying the various phases 
 of cases which we have an opportunity of closely watch- 
 ing, that we can hope to contribute anything towards the 
 solution of one of the most complex questions in 
 cerebral pathology — a question about which so much has 
 lately been written, and about which, it seems to me, so 
 little is at present really known. 
 
author's own cases. 99 
 
 It will be observed that in several of my cases I have 
 given the volumetric analysis of the principal solid 
 ingredients of the urine. This, to some persons, may 
 seem a work of supererogation ; to those I would say 
 that the diagnosis of cerebral disease is in many instances 
 attended with so much difficulty, that the serious and 
 conscientious observer is bound to avail himself of every 
 collateral aid within his reach ; the metabolism of the 
 various tissues of which the animal body is composed, 
 which occurs during life, is accompanied by the for- 
 mation of certain products which require to be removed, 
 and it cannot be otherwise than useful, systematically to 
 calculate the amount of phosphorus and other constant 
 or occasional solid ingredients of nervous tissue which 
 are daily eliminated from the system, for the presence, 
 in greater or less quantities, of these substances in the 
 animal economy, and their morbid manifestations, are 
 subjects of deep interest to the practical physician. 
 
 The following cases present various degrees of the 
 affection, from the uncomplicated pure form of aphasia — 
 where there is simply abolition or suspension of speech 
 without any paralytic or other morbid symptom — to the 
 partial or even occasional impairment of that faculty ; 
 and here I would remark that in making investigations 
 with the view of elucidating any obscure symptom or 
 disease, the common error into which many observers 
 fall, is to confine their attention to the consideration of 
 typical cases only — cases where the symptom or disease 
 is well marked and defined ; whereas, as much or more 
 information may sometimes be gained from the careful 
 study of exceptional cases, and of cases where the par- 
 ticular symptom or disease is only slightly marked. 
 
100 APHASIA, OR LOSS OF SPEECH. 
 
 Impressed with these views, I have for some time past 
 made careful notes of all cases that have fallen under my 
 observation, where the faculty of articulate language was 
 affected in any way or degree, however slight, deeming 
 it quite as useful to study cases where the lesion of 
 speech is a mere epiphenomenon, as where it forms the 
 principal or the sole morbid symptom. 
 
 Case I. — Aphasia of the ataxic form, occur- 
 ring AS THE EARLIEST MORBID SYMPTOM ; SOME 
 
 months later verbal amnesia; epileptiform 
 Convulsions; ultimately General Paralysis. 
 Autopsy — Circumscribed Softening in both 
 posterior lobes; Frontal Convolutions un- 
 affected. 
 
 William Sainty, a waterman, aged fifty-one, was admitted under 
 my care into the Norfolk and Norwich Hospital, April ist, 1865, 
 with the following antecedent history : — He had always lived a 
 temperate and steady life, had never contracted syphilis, nor 
 suffered from any rheumatic affection — in fact, he had always 
 enjoyed excellent health quite up to the period of the present 
 attack, which was not preceded by any premonitory symptoms of 
 brain or nervous disorder. 
 
 On the 9th of December, 1864, after unloading his vessel, in 
 which he had conveyed a cargo of goods from Norwich to 
 Yarmouth, a distance of thirty miles, he went into a tavern with 
 the intention of asking for some beer, when to his astonishment 
 and concern, he found he could not speak — the power of articula- 
 tion was suddenly and completely suspended. Nothing odd or 
 peculiar had been observed in his manner, and he had only a few 
 hours previously called at a merchant's office and arranged about a 
 fresh cargo, when his aptitude for business was in no wise 
 impaired. The loss of speech then was sudden, and was clearly 
 
LOSS OF SPEECH THE SOLE MORBID SYMPTOM. IOI 
 
 unaccompanied by any other paralytic symptom, for although 
 speechless, he, on the same evening, removed his vessel from one 
 point of the river to another, and on the following day loaded it 
 with a fresh cargo, after which, unaccompanied by any of his friends 
 or comrades, he took the train to Norwich, and on his arrival 
 walked from the railway station to his own home, a distance of a 
 mile. His friends, alarmed at finding that his vocabulary was 
 limited to the words " Oh ! dear! oh! dear!" sent for a surgeon, 
 under whose care he continued till a few days before he came to 
 the hospital. 
 
 I have not been able to procure any very accurate information as 
 to the precise time during which the abolition of speech was com- 
 plete ; it would seem, however, that after three days he could say 
 a few words, but that it was not till the expiration of a fortnight 
 that there was any marked improvement ; after this period the 
 progress towards the partial recovery of his speech seems to have 
 been gradual. Some time in February he experienced a slight 
 abnormal nervous symptom, characterised by numbness in one of 
 the fingers of the right hand. A month later he had a kind of fit, 
 falling down, and remaining for a few minutes unconscious. 
 
 Symptoms on Admission. — His condition is that of a healthy- 
 looking man, with a remarkably intelligent countenance, looking 
 me straight in the face when addressed, and evidently understanding 
 all that is said ; but although his ideas seem to arise in great 
 number in his brain, and there is no want of sequence in his 
 thoughts, he is unable to give expression to those ideas by articu- 
 late language, except in a very imperfect manner. There is, also, 
 partial agraphia, for although just able to form one or two words, 
 he cannot write a sentence, he being able to write fluently and well 
 before the present attack. He has the proper use of all his limbs, 
 which are free from the slightest abnormal sensation. The 
 peripheral instruments of language are unaffected ; the tongue is 
 protruded straight, and he can execute all the different movements 
 appertaining to that organ. The only feature to notice in the tongue 
 is, that the right half is slightly raised above the level of the left 
 half, and is more flabby, and also that when told to protrude the 
 tongue, he keeps it out a long time, as if from a defect of memory, 
 probably not remembering what he had done ; the power of 
 deglutition also is unaffected. There is no abnormal sensation about. 
 
102 APHASIA, OR LOSS OF SPEECH. 
 
 the head, and the organs of special sense are unimpaired. He is 
 very cheerful, and does not weep from emotional causes, like persons 
 with ordinary paralysis ; nor has he that distressed countenance 
 usually observed in the subjects of grave cerebral disorder ; in fact, 
 there is nothing in his appearance to denote the disorder with which 
 he is troubled. The heart's action is feeble, with occasional inter- 
 mittence, but no evidence of valvular disease. Pulse, 72. Urine, 
 sp. gr. 1020, freely acid ; no albumen ; and a volumetric analysis of 
 the principal solid ingredients gave the following result : — 
 
 Chlorides - 10.5 parts per 1000 
 
 Urea ----- 26 ,, ,, 
 
 Phosphoric acid (in combination) 1.5 ,, ,, 
 
 So long a time having elapsed since the attack which had pro- 
 duced the impairment of speech, I felt that but little could be done 
 in the way of treatment. I prescribed for him small doses of the 
 phosphates of iron and zinc, with dilute phosphoric acid, and under 
 this treatment, together with a careful attention to diet, he slightly 
 improved, the improvement being, however, more marked in his 
 power of writing than in speaking. Discharged June 3rd. 
 
 Shortly after his discharge he resumed his work as a waterman, 
 when no untoward symptom occurred till January, 1866, when, after 
 a morning's work, as he was going into his cabin to prepare for 
 dinner, he fell to the ground quite unconscious, and came to him- 
 self in about a quarter of an hour ; but his speech for some hours 
 was more embarrassed than usual ; there was, however, no paralysis 
 on recovery, for he resumed his work the same day. At the end of 
 February (a month later) he again fell in his cabin, frothed at the 
 mouth, was livid in the face, and remained unconscious half an 
 hour ; on recovery, there was increased embarrassment of speech 
 for some hours, but before night he was as usual. There seems to 
 have been no convulsive movements on either of these two occasions. 
 After the above date he had a similar fit every few weeks. 
 
 Re-admitted ' Jamiary 12th, 1867. — He seems still in possession of 
 all his intelligence, has no paralysis, nor even diminution of motor 
 power. He understands all that is said, but is affected with an 
 incapacity to employ substantives, having lost the memory of words 
 
IDEAS PRESENT ; BUT WORD-IMAGES WANTING. 103 
 
 as far as that part of speech is concerned, and he will make use of 
 a periphrase to avoid using the substantive required. He has very 
 clear ideas as to what he wishes to say, is aware that he is wrong in 
 the use of words, is vexed at his blunders, and is ingenious in con- 
 triving means to counteract or avoid them. If asked to fetch an 
 object, he will bring the right, but if he wants anybody else to fetch 
 or give him anything, he more commonly asks for the wrong thing 
 first, afterwards correcting himself, showing that he understands 
 perfectly what he wants. If shown anything, he will say that he 
 knows what it is, but cannot say it. On being shown a purse, and 
 being asked what it was, he answered, " I can't say the word; I 
 know what it is ; it is to put money in," " Is it a knife ?" " No." "An 
 umbrella?" "No." "Apurse?" "Yes." I showed him a poker. "What 
 is it?" "I know, but I cannot say the word." "What is its use?" "To 
 make up the fire." " Is it a walking stick ?'' "No." " Is it abroom ?'' 
 "No." "Is it a poker?" "Yes," he said, instantly, with a smile evincing 
 complete understanding of the question, and joy at the certainty 
 that he had answered it right. It was evident, therefore, that the 
 words representing his ideas were preserved in the treasury of his 
 memory, but the mere origination of the ideas was not sufficient 
 to effect the verbal expression of them ; it was necessary that the 
 process should be aided by the patient hearing the required words 
 pronounced by another person. 
 
 March 30//^ — The house surgeon was called to him to-day, and 
 found him stretched on the floor, twitching convulsively, with turgid 
 face, gnashing of the teeth, foaming at the mouth, eyes open and 
 rolling, pupils dilated and insensible to light, breathing stertorous, 
 skin cold and clammy. These symptoms continued for fifteen 
 minutes, when violent jerking of the left leg and thigh occurred, the 
 convulsive efforts ceased, and he gradually recovered his senses ; 
 there was no paralysis. 
 
 March 3 1 st. The patient had a sound sleep after the fit of yester- 
 day, and to-day is as usual. 
 
 On showing him a tumbler glass he shakes his head, and says it 
 is for beer, but cannot remember its name ; he knows it is not called 
 a basin, a mug, or a jug, and recognises the word "glass" directly it is 
 named ; but the next minute he has forgotten it, and cannot repeat 
 it. He was also shown a warming pan, about which he became 
 quite angry from his inability to remember its name; he, however, 
 
104 APHASIA, OR LOSS OF SPEECH. 
 
 showed his interrogators what it was used for, with great despatch, 
 and recognised its name the moment it was casually mentioned. 
 
 April 2\th, — Suddenly taken speechless, with loss of motor power 
 in the lower limbs, the upper extremities being unaffected. The fit 
 was evidently entirely different from any other he has had ; there 
 were no epileptiform convulsions ; simply faintness, speechlessness, 
 and paraplegia. The pupils were equal and active ; he appeared 
 conscious of all that was going on around him, and as soon as he 
 was put to bed he uttered confused sounds, but could not articulate. 
 
 2$th. — The motor power in the lower limbs has partially returned ; 
 in fact, there is no actual paralysis this morning, there is simply 
 want of co-ordinating power of the lower limbs ; he can walk very 
 imperfectly, supported by two persons, but cannot stand alone. 
 
 May 2nd. I was summoned to him to-day, and found him in an 
 epileptic fit, perfectly unconscious, pupils both contracted and im- 
 movable, foaming at the mouth, with convulsions, which were 
 confined to the right arm and leg and right side of the face ; the 
 right orbicularis palpebrarum was contracting violently; the left side 
 of the body seemed unaffected ; the convulsions soon affected both 
 sides, the left, however, to a much less extent. Five grains of 
 calomel to be put upon the tongue, and a turpentine injection to be 
 administered. 
 
 3rd. — He is still quite unconscious — in fact, in a state of epileptic 
 coma ; pupils still contracted, and immovable, and there is imper- 
 fect right hemiplegia, without loss of sensation. 
 
 /\th. — The hemiplegia has passed off, there being only a little less 
 power in the arm ; consciousness is returning. 
 
 $th. — Pupils still contracted and insensible to light ; he has 
 recovered consciousness, and has evidently now the use of all his 
 limbs. He cannot stand alone, but he walked some yards this 
 morning, with the assistance of two persons. He puts his hand to 
 his forehead as if in pain, and he is becoming restless, and requires 
 a person constantly by his side to keep him in his bed. 
 
 In a few days he had gradually recovered the power to stand and 
 even walk alone a few steps ; he continued, however, quite unable 
 to speak, although he would make certain sounds intended to convey 
 his thoughts. It was soon found that his moral passions had under- 
 gone a change, and that from a particularly quiet, modest, and well- 
 behaved, inoffensive man, he had become indecent, exposing his 
 
author's own cases. 105 
 
 person, revengeful, and spiteful. His mind soon gave way, he 
 became imbecile and quite unmanageable, and it was soon found 
 necessary to remove him to the Borough Asylum. 
 
 ] 868, July gih. — I visited him to-day at the Asylum, and found 
 him seated on a bench. He evidently recognised me, but was quite 
 unable to speak a single word, and he evinced the greatest distress 
 at his inability to converse with me. He had gained flesh, and 
 looked well. Mr. Sutton, the resident medical officer, reported to 
 me that about four months ago he had a series of epileptiform con- 
 vulsions lasting forty-eight hours, and that he was, to all appearance, 
 dying; he, however, soon recovered from this condition, but con- 
 tinued very helpless and unable to walk or even stand without 
 assistance, although when supported by two persons he could walk 
 a considerable distance. Mr. Sutton further reported that although 
 unable to articulate, he gesticulates frightfully, and thus endeavours 
 by the language of signs to supply the loss of articulate language. 
 In further illustration of his psychological condition, I would add 
 that his sister informs me that some months since, upon the occasion 
 of his nephew playing*the cornet in his presence, he, supported by 
 two women, danced to the tune. 
 
 Soon after my visit to the Asylum, this patient died 
 from exhaustion after another epileptiform seizure, of a 
 similar kind to those described above. 
 
 Autopsy. — The cranium was somewhat thickened ; the dura mater 
 much more so. Intense congestion of the convex surface of the 
 hemispheres, decidedly more marked on the left side ; considerable 
 opacity of the arachnoid, also more apparent on the left side. A 
 little flattening of the convex surface of the left anterior lobe. In 
 the middle of the left posterior lobe was an ai - ea of softening of 
 about the size of an apricot ; a similar condition existed also at the 
 same spot in the right hemisphere, but the softening was not so far 
 advanced. The frontal convolutions were especially examined, but 
 no trace of softening or other disease was discovered; the central 
 ganglia, pons, and cerebellum were also healthy. There was a want 
 of firmness in the brain generally, but no appearance of hemispheric 
 
106 APHASIA, OR LOSS OF SPEECH. 
 
 disease elsewhere than as above stated, although various portions 
 were submitted to a careful microscopic examination. All the 
 arteries of the base of the brain were atheromatous ; the left middle 
 cerebral was completely filled by a fibrinous plug, and the left 
 vertebral contained a small thin red filiform fibrinous cast, occupying 
 only about a quarter of the diameter of the vessel. The heart 
 weighed 1 1 V ounces ; the left ventricle was hypertrophied. There 
 was narrowing of the mitral valve, with considerable atheroma at 
 its base, as also at the base of the aortic valves. Considerable 
 dilatation of the tricuspid orifice, with slight thickening of the valve 
 itself. The weight of the encephalon, stripped of dura mater, was 
 47 ounces. 
 
 The above case seems to me to be pregnant with 
 material for careful thought and study, and if I have 
 dwelt thus minutely on its daily progress, it is because I 
 apprehend that it is not common to have the opportunity 
 of watching for so long a time a patient presenting such 
 an exceptional chain of symptoms. I shall now proceed 
 to analyse the various phases which the clinical history 
 of this man has from time to time presented. 
 
 The sequence of disordered action here is curious. The 
 very first morbid symptom was total loss of speech; after 
 partial recovery of the faculty of speech, verbal amnesia 
 was observed — loss of the memory of words limited to 
 substantives ; the idea was present, but the word was 
 wanting ; the idea rose up in his mind, but the accompany- 
 ing word-image was wanting ; the association between the 
 word and the idea was interrupted, although articulation 
 was at the service of the word, for the word immediately 
 emerged, and could be correctly uttered, as soon as it was 
 either spoken or read before the patient ; then epilepti- 
 form convulsions set in, and, alternating with each other, 
 hemiplegia and paraplegia ; and eventually this curious 
 
AUTHORS OWN CASES. 107 
 
 chaia of morbid symptoms merged into a state of 
 general paralysis. 
 
 The loss of speech was, in the first instance, of the 
 ataxic form, for no amount of prompting would help him. 
 As the abolition of speech was complete, it is, however, 
 impossible to say whether or not there was at this time 
 verbal amnesia also. Probably there was, for when the 
 ataxic symptoms gave way, loss of the memory of words 
 was soon observed. Dr. William Ogle* mentions two 
 cases in which, after recovery from the ataxic form of 
 aphasia, amnemonia remained, which he thinks must have 
 co-existed at the earlier stage with the ataxia ; in both 
 Dr. Ogle's cases, however, there was hemiplegia, indicating 
 a much more extensive lesion of brain than could have 
 been suspected at this stage of Sainty's history. 
 
 The next feature to which I wish to call attention is, 
 that not only was the total loss of speech the earliest 
 symptom, but it was for some days the sole symptom. 
 There was no paralysis — there was simply privation of 
 the power of speech ; it was simple aphasia, in the rigor- 
 ous sense of the term — and cases such as this would seem 
 to show that the faculty of speech may perish, or be 
 suspended, alone, and that this faculty is special and 
 independent. 
 
 The muscular apparatus, which served for the articu- 
 lation of words, was in a perfect state of integrity, but an 
 indispensable element was wanting; the vocal instrument 
 was intact, but the artist was unable to make use of it. 
 
 * "On Aphasia and Agraphia." "St. George's Hosp. Reports," 
 vol. ii., 1867. This interesting and highly instructive communication 
 contains the careful analysis of 25 cases, which have furnished Dr. Ogle 
 with the material for one of the most useful papers that have been 
 published on this subject, 
 
108 APHASIA, OR LOSS OF SPEECH, AND 
 
 When the aphasia had assumed the amnesic form, the 
 defect was dependent on loss of the memory of words ; 
 but in the earlier stage, when the ataxic form was present, 
 was the defect due to the loss of the memory of the 
 movements necessary for speech ? 
 
 The complete but temporary loss of speech in the early 
 stage, I presume, was the result of a simple ephemeral 
 cerebral congestion, probably situated in the same part 
 of the brain as that, which, being subsequently more 
 seriously injured, gave rise to the more permanent 
 symptoms. 
 
 The occurrence of paraplegic symptoms after one fit, 
 and of hemiplegic symptoms after another, is worthy of 
 notice. I will not attempt to offer any theoretical specu- 
 lation as to the cause of the temporary loss of motor 
 power in the lower limbs ; I simply notice it as singular 
 and exceptional. The transitory hemiplegia, I presume, 
 can be explained on the supposition of temporary obstruc- 
 tion, or rather spasm of the middle cerebral artery, and 
 the term hemispasm, as suggested by Dr. Hughlings 
 Jackson, would be more appropriate to such a condition 
 than hemiplegia. 
 
 I wish to call particular attention to the fact that the 
 lesion which could produce total abolition of speech for a 
 considerable time, did not in the least impair the intellect* 
 for when he came under my care some months afterwards, 
 he seemed possessed of more intelligence than most men 
 of his class ; he had plenty of ideas, the defect was the 
 inability to clothe the ideas with the proper symbols 
 necessary to convey them. I may here remark that the 
 opinion of those who have written upon this subject is 
 divided, as to whether the intelligence, is, as a rule, 
 affected in aphasia. Trousseau held the opinion that the 
 
ITS RELATION TO INTELLECTUAL CAPACITY. 109 
 
 mental faculties were always more or less impaired ; on 
 the other hand, the case of Professor Lordat has been cited 
 as a proof that the aphasic condition may exist with the 
 highest amount of intellectual activity. It seems that 
 the illustrious Montpellier professor was at a certain period 
 of his life affected with aphasia, and he has himself 
 stated that, although speechless, he experienced no re- 
 straint or difficulty in the exercise of thought and imagi- 
 nation. He prepared his lessons, he arranged his subject, 
 and was able mentally to dwell on the salient points. 
 " J e posse'dais completemcnt" dit-il, " la partie interne du 
 langage,je 11 en avais perdu que la partie exteme" 
 
 The question has arisen in my own mind, as to whether,- 
 during the early part of Sainty's illness, he was capable 
 of making a will. The testamentary capacity of aphasics 
 is an important medico-legal question, which I purpose 
 considering in a subsequent chapter. 
 
 Case II. — Amnesic Aphasia, with right Hemi- 
 plegia. Autopsy — Softening of the posterior 
 part of the left hemisphere; anterior lobes 
 
 HEALTHY. 
 
 On the 20th of March, 1867, 1 was requested to see Mr. N , a 
 
 merchant, set. 51, with no hereditary antecedents of mental or ner- 
 vous disease in his family, who, for a period of three or four months, 
 had experienced abnormal symptoms, indicating want of brain power. 
 For some time previous to this date his friends noticed that he had 
 become unusually quiet, less communicative, and dull. Shortly 
 before Christmas, he had a sort of fainting fit, and soon afterwards 
 he began to get confused in his conversation ; he would let objects 
 drop from his right hand, and do awkward things at the table— on 
 one occasion he put vinegar on his repast instead of pepper. It 
 
110 APHASIA, OR LOSS OF SPEECH. 
 
 was soon observed that he could not write a letter. From inquiries 
 which I instituted in reference to his habits, it seems that he had 
 led a fairly temperate and steady life, and that the only cause which 
 could be assigned was the excitement and mental tension resulting 
 from an entire change of occupation ; he having a few years pre- 
 viously exchanged the comparatively mechanical and automatic life 
 of a country village, for a business of a speculating character in a 
 large town, necessitating railway journeys to London twice a week. 
 I ought to add, however, that within a comparatively recent date 
 he had accidentally received a severe blow on the head. 
 
 During my somewhat lengthened interview with him, he never 
 initiated any subject of conversation. When I questioned him, he 
 seemed to get confused, and was conscious of this confusion, saying 
 he could not find words to describe his symptoms. What answers 
 he made, however, were given quite coherently, but in the fewest 
 possible words. He seemed to understand everything that was 
 said, but he had, to a certain extent, lost the memory of words, and 
 would call things by their wrong names — for instance, being in a 
 room where the fire was burning particularly brightly, he said, " How 
 bright the poker looks." The person to whom he was speaking, 
 said, "You mean the fire." "Yes," he said, "I mean the fire." 
 He would be thus confused in the choice of words to express his 
 thoughts, and the knowledge of this defect was a source of distress 
 to him. The idea was conceived, but the means of communication 
 with the external world did not exist. He complained of numbness 
 in the right arm and leg, and the tactile power of the right hand 
 was impaired. The heart's impulse was feeble, with no abnormal 
 sound ; the pupils were sluggish, and he complained of frequent 
 dizziness and Of frontal headache. His pale and pasty aspect, 
 diminished secretion of urine, and other symptoms caused me to 
 deem it necessary to look carefully into the condition of the kidneys. 
 The analysis of the urine gave the following results : — quantity 
 passed in 24 hours, 26 ounces, sp. gr. 1030, no albumen, some pale 
 lithates. A microscopic examination revealed the presence of 
 amorphous lithates, a few oxalates, and several oil globules and fat 
 cells. 
 
 Chlorides ------ 4 parts per 1000 
 
 Urea ------ 16 ,, „ 
 
 Phosphoric acid, in combination - 3*2 „ ,, 
 
author's OWN CASES. Ill 
 
 The condition of this patient was not materially altered for some 
 weeks, when, after dressing himself one morning, he was profusely 
 sick, and his symptoms suddenly culminated into an apoplectiform 
 seizure, with right hemiplegia and total loss of speech, the latter 
 symptom being the result of a state of coma, from which he never 
 rallied. 
 
 Autopsy. — There was considerable congestion of the veins on the 
 convex surface of the brain, but there was no opacity of membranes 
 or other morbid appearance, either on the upper surface or at the 
 base. The vessels composing the circle of Willis, and the arteries 
 generally, were quite healthy, both middle cerebral arteries being 
 specially examined and traced along the fissure of Sylvius, without 
 any abnormal appearance being detected. At the point of union of 
 the middle third with the posterior third of the convex surface of 
 the left hemisphere, was a dilatation, or bulging out of the arach- 
 noid, giving the appearance of a cyst. This contained at least two 
 drachms of serum, the evacuation of which disclosed a tolerably 
 well circumscribed portion of softened cerebral tissue, of about the 
 size and shape of an apricot, with its upper segment depressed, so 
 as to form a cup-shaped cavity. It was here the serum was lodged, 
 and there was at this spot an actual destruction of cerebral matter ; 
 the softened tissue was of a yellowish grey colour, resembling a 
 strong solution of gelatine in appearance. In the centre of this 
 softened portion was a very small clot, or rather layer, of black 
 blood, of about the size of an ordinary wafer. From the small size 
 of the clot, and the great extent of the softening, it must be in- 
 ferred that the softening preceded, and was the cause of the clot, 
 and the recent date of the sanguineous effusion would also favour 
 this view. The frontal convulutions were examined with great care, 
 especially the third, and the substance between it and the corpus 
 striatum, but these structures were found quite healthy. The dis- 
 ease was, in fact, limited to the posterior third of the left hemisphere. 
 The heart was covered with an unusual layer of external fat ; its 
 muscular substance was pale and flabby, and its walls attenuated. 
 The kidneys were healthy, but congested, and somewhat below the 
 normal size. The spleen was very soft and friable. 
 
 Doubtless it will be said by some that this is scarcely 
 
 a case of aphasia. It is certainly by no means a typical 
 
 H 
 
112 APHASIA, OR LOSS OF SPEECH. 
 
 instance of the affection, like the preceding case ; but as 
 I am treating of lesion as well as of loss of speech, I 
 think it deserves recording as an instance of the loss ot 
 the memory of words and impairment of the faculty of 
 language, dependent upon softening of the posterior part 
 of the left hemisphere, with perfect integrity of the frontal 
 convolutions and of the anterior lobe generally. In the 
 former part of this essay, I have already cited a case of 
 Abercrombie, somewhat resembling this, and where the 
 softening was also found in the posterior part of the left 
 hemisphere. 
 
 Case III. — Right and subsequently Left 
 Hemiplegia, with Lesion of Speech ; effects of 
 Electricity. Autopsy — Hemorrhage into the 
 central part of each hemisphere; frontal 
 Convolutions sound. 
 
 John Sutherland, a shoemaker, aged 60, was admitted into the 
 Norfolk and Norwich Hospital, December 22nd, 1866, with the 
 following history. He had not been a drinking man, had smoked 
 very little, had suffered from gonorrhoea, but had never had syphilis 
 or rheumatic fever. Whilst at work on September 4th, he suddenly 
 lost the entire use of his right side, and also of his speech. The 
 loss of articulate language was almost complete for about a fort- 
 night, at the expiration of which time he could just make himself 
 understood by those who knew him well ; the partial recovery of 
 his speech coincided with a little returning motor power in the leg, 
 but it was not till two months later that there was any improve- 
 ment in the hand. 
 
 Condition on Admission. — There is still considerable loss of 
 power in the right arm, and the fore-arm is contracted on the arm . 
 he walks with difficulty, but there is less impairment in the use of 
 the leg than of the arm. 
 
author's own cases. 113 
 
 The memory and intellect are unaffected ; he answers questions 
 remarkably readily, and there is now no hesitation in his speech, 
 but he speaks in a muffled, unnatural tone, as if the mouth was full- 
 There is no evidence of cardiac disease, no unilateral sweating; he 
 fancies he cannot smell as well as before the attack. 
 
 There was nothing in the treatment of this case to record, except 
 that, some weeks after his admission, galvanism was twice applied 
 to the right leg, but this seemed to aggravate his condition, for in 
 a few days there was complete paralysis of this limb. 
 
 Some days later he had a severe apoplectic seizure, resulting in 
 paralysis of the entire left side, with great difficulty of speech, and 
 he died in a few days. 
 
 A most careful post-mortem examination was made, which I will 
 not describe in detail ; suffice it to say that the loss of motor power on 
 the two sides was explained by a clot in the central part of each 
 hemisphere ; there was no obstruction of the middle cerebral 
 arteries, and we clearly satisfied ourselves that the frontal convo- 
 lutions were in no wise affected. 
 
 Independently of the integrity of the frontal convolu- 
 tions, there are one or two other points in this case calling 
 for a passing remark. It will be observed that galvanism 
 caused a decided aggravation in his symptoms. This 
 powerful remedial agent cannot be used with too great 
 caution and discrimination in cases of paralysis, and I 
 take blame to myself for having allowed its use here ; 
 for the contracted state of the forearm was indicative of 
 a state of irritation and of exalted polarity of the nervous 
 tissues, likely to be aggravated by electrical stimulus. 
 
 Although the increase of the dextral paralysis was un- 
 accompanied by any fresh aphasic symptoms, it will be 
 observed that the occurrence of left hemiplegia coincided 
 with great difficulty of speech. Those who view cases 
 partially and distort them to suit their own notions, 
 would, in a statistical table, put this down as a case of 
 
114 APHASIA, OR LOSS OF SPEECH. 
 
 left hemiplegia with aphasia ; whereas it is evident that 
 the difficulty in speaking which occurred during the last 
 few days of his life, was due to a semi-comatose condition, 
 induced by sudden cerebral haemorrhage, and which 
 rapidly ended in death. I have recorded his fancied loss 
 of smell, because I think it important in all cases to 
 notice the state of the olfactory function. 
 
 Case IV. — Aphasia, with Right Hemiplegia. 
 Autopsy — Bony deposit in the left middle 
 cerebral fossa; no lesion of frontal convo- 
 LUTIONS. 
 
 The subject of this case, Mr. C. G , was a gentleman, aged 
 
 36, who had led a very gay life, and who had on several occasions 
 been affected with a severe form of venereal disease ; he had also 
 suffered from rheumatic fever. For many years he had been at 
 times the subject of great mental excitement, and even to some 
 extent of mental delusions. There was no hereditary predispo- 
 sition to insanity in his family, but two of his brothers were 
 affected with paralysis of the right side, the paralysis being in one 
 of them attended with considerable impairment of speech. 
 
 In the year 1865 he entered into the married state, and, four 
 months afterwards, his habitually excited condition much increased, 
 and it became necessary to place him in an asylum. He now soon 
 began to hesitate in his speech, and to give evidence of the loss of 
 the memory of words ; his power of writing also became impaired. 
 Some months later he was suddenly attacked with convulsions, 
 followed by right hemiplegia, with total loss of speech, and he died 
 in a few days. 
 
 I was invited by his medical attendant to be present at the 
 autopsy, when there was found evidence of chronic thickening of 
 the arachnoid, with congestion of the pia mater of the left side 
 especially ; there was no clot, no degeneration of cerebral matter ; 
 the anterior convolutions were especially examined, and found quite 
 
author's own cases. 115 
 
 healthy. The most remarkable appearance that this examination 
 disclosed, was a deposit of rough bony matter — exostosis, at the 
 centre of the fossa corresponding to the middle lobe of the brain 
 on the left side, and to this rough surface the cerebral membranes 
 were slightly adherent. 
 
 In the absence of any more decided cause, I presume 
 the diseased condition of bone might account for the 
 convulsions ; but the case is curious from the fact of the 
 hemiplegia being so decided without any disease of the 
 central ganglia or of the hemispheres. The fo?is et origo 
 mali was undoubtedly the syphilitic taint. The occur- 
 rence of dextral paralysis, with dysphasia, in his brother, 
 is just worthy of observation ; in the account of Dr. 
 Scoresby Jackson's remarkable case, it is stated that 
 another member of the same family was affected with 
 lesion of speech and paralysis of the right side* 
 
 In reference to the subject under discussion, I wish 
 more particularly to call attention to the fact that this 
 and the two preceding cases may be considered as directly 
 opposed to Professor Broca's theory ; in all three the 
 frontal convolutions were examined with a scrupulous 
 care, and were found quite healthy, and in the case of 
 
 Mr. N. , which was a marked instance of the amnesic 
 
 form of aphasia, the lesion was not near the anterior lobe 
 at all, being situated at the posterior part of the upper 
 surface of the hemisphere. With every desire to avoid 
 the common error of drawing definite conclusions from a 
 limited number of observations, I would add that three 
 negative cases, supported by post-mortem verification, go 
 
 * Dr. Sumpter, of Cley, has recorded in the "Lancet," of October 3rd, 
 1868, a brief note of two cases of Aphasia then under his care, in which 
 the patients stood in the relation to each other of mother and daughter. 
 
Il6 APHASIA, OR LOSS OF SPEECH. 
 
 far to outweigh three hundred cases, apparently admitting 
 of a different interpretation, but where no autopsy was 
 made. 
 
 It is somewhat singular that in each of the above three 
 cases there existed an abnormal condition of the left 
 side of the base of the skull. In one case, as above 
 stated (Mr. C. G.), there was actual disease of bone ; in 
 
 the case of Mr. N. there was an unusual development 
 
 of that part of the petrous portion of the left temporal, 
 which corresponds to the perpendicular semi-circular 
 canal ; and in Sutherland's case there was a remarkable 
 bony prominence in the left middle fossa, not existing on 
 the other side. It will doubtless be said that unsym- 
 metrical development of the two sides of the skull is not 
 uncommon. I quite admit this, and I desire simply to 
 record what I have observed, without attempting to draw 
 any inference from such observation. I cannot but think, 
 however, that it would be extremely desirable, in future 
 autopsies of persons who during life exhibited symptoms 
 of lesion of speech, that the condition of the bones of the 
 skull should be minutely examined, and any unusual 
 appearances accurately recorded. 
 
 Case V. — Loss of Speech of an intermittent 
 
 CHARACTER, WITH PARAPLEGIA ; SPINAL SYMPTOMS. 
 
 George Green, a shoemaker, set. 38, was admitted into the Norfolk 
 and Norwich Hospital on February 10th, 1866. He had been 
 affected with syphilis, but never suffered from any rheumatic affec- 
 tion. His first symptom was pain in the forehead and dimness of 
 vision, for which he was treated as an out-patient at University 
 College Hospital in the early part of 1864; up to this period he 
 had been a most inveterate smoker, which habit he at once discon- 
 tinued, at the request of Dr. Wilson Fox. 
 
author's own cases. 117 
 
 During the summer of 1864, whilst at work, he suddenly lost the 
 power of speech, there being at the same time an aggravation of the 
 habitual frontal pain, but no symptom of paralysis, and he resumed 
 his work next day. The total cessation of speech lasted about 
 twenty minutes or half an hour, when the only symptom in connec- 
 tion with the power of speech, was a slight hesitation and embar- 
 rassment which lasted three or four days, and then as far as his 
 speech was concerned, he was as well as ever. In about three 
 weeks after the above symptoms, he was obliged to discontinue his 
 work in consequence of being seized with a tingling feeling, running 
 from the extremities of. the right fingers, along the arm to the top 
 of the shoulder, and up to the right angle of the mouth ; there was 
 evidently partial paralysis, as he could not hold anything, and there 
 seems to have been anaesthesia, as he speaks of numbness and loss 
 of feeling ; the paralytic symptoms were entirely confined to the 
 right upper extremity. These symptoms disappeared in about two 
 hours, and he resumed his work, no treatment having been adopted. 
 
 About January, 1865, he began to feel a tired sensation in his 
 legs, as if he had been walking a long distance ; at the same time 
 he noticed some difficulty in passing his water, and an habitual 
 constipation began to increase. Six months later he again lost his 
 speech whilst reading, the loss of the power of utterance being pre- 
 ceded by a swimminess in the head and dimness of vision : he went 
 to bed, fell asleep, and after three hours woke with the speech 
 restored, but only a little embarrassed ; the next day all was right. 
 He has never had dysphagia, and when the power of speaking has 
 been suspended, the movements of the tongue have been unim- 
 paired. 
 
 Symptoms on admission.— -He is quite unable to stand or walk 
 without assistance ; there is no deviation of, or pain on pressure 
 over the spine, except slightly at the neighbourhood of the lower 
 dorsal vertebras ; there is no paralysis of the upper extremities, and 
 the organs of special sense are unimpaired. The tongue is furred, 
 the bowels are constipated, rarely acting more than once a week ; 
 there is difficulty in passing his water, but only at night when in 
 the recumbent posture. There is no evidence of cardiac disease. 
 
 In the absence of any positive therapeutic indication, and with 
 the possibility of his symptoms being due to a remote syphilitic 
 
Il8 APHASIA, OR LOSS OF SPEECH. 
 
 cause, I prescribed small doses of perchloride of mercury, and a 
 cathartic electuary at bedtime. 
 
 March 26th. — For several days has not felt so well, has had but 
 very little sleep ; had an attack yesterday similar to his former ones, 
 but much slighter in degree — the speech was affected for about two 
 hours, but much less so than on former occasions. He attributes 
 his relapse to want of sleep ; he complains to-day of tingling and 
 numbness in the left little finger, which has been present for four or 
 five days. 
 
 He derived some slight benefit from treatment, and left the 
 hospital on the 12th of May. Thinking this a case in which it was 
 very desirable to ascertain in what proportions the principal solid 
 ingredients of the urine were present, I made a careful volumetric 
 analysis of that secretion a few days before his discharge, with the 
 following result : — 
 
 Chlorides 7-5 parts per 1000 
 
 Urea .... 17 „ 
 
 Phosphoric acid (in combination) i*i „ „ 
 
 Quantity passed in 24 hours, four pints, sp. gr. 1014 ; reaction, 
 alkaline. 
 
 Re-admitted December 1st. — Omitting unimportant details, I pass 
 on to January 19th, 1867, when I find the following entry : — He 
 awoke in the middle of last night, and found that he had lost his 
 speech, this phenomenon being preceded by violent pains in both 
 brows, just above the external angular process. He feels the pain 
 in his forehead to-day, but the speech is now all right. 
 
 22nd. — He has vomited some bilious matter, and had early this 
 morning a tingling up the right arm up to the side of the mouth. 
 
 February \6th. — No marked difference in his symptoms since 
 admission, except that there is now rather sharp pain caused by 
 pressure over the 8th and 9th dorsal vertebrae, and from this spot 
 downwards ; for some weeks past also there has been pain at this 
 region when not touched. This patient soon afterwards left the 
 hospital, and I heard nothing more of him, till his father came one 
 day to say he had died quite suddenly. I regret I was not permitted 
 to make a. post-mortem examination. 
 
author's own cases. 119 
 
 The history of this patient is suggestive of the caution 
 with which we should accept any statistics based upon 
 cases only casually observed, or which have been under 
 observation but a short time. Had this case been reported 
 in its early stage, when there were abnormal symptoms 
 present in the right upper extremity, it would perhaps 
 have been recorded by some enthusiastic aphasiographer, 
 as a case of aphasia with imperfect right hemiplegia, and 
 it would thus have been cited with others to prove the 
 correctness of Dax's theory; whereas, as time elapsed 
 and other links were added to the morbid chain, para- 
 plegia set in, and in fact there never was really any 
 persistent paralysis of the upper extremities. 
 
 I do not wish to indulge in any hypothetical specula- 
 tions as to the seat of this man's disorder. There was 
 never any permanent symptom pointing directly to cere- 
 bral disease ; whereas the persistent paraplegia and loss 
 of function of the bladder and rectum, together latterly 
 with tenderness and pain at the lower part of the spine, 
 justified me in looking upon his symptoms as due to 
 disease of an insidious nature in the spinal cord. 
 
 I have already mentioned, in a former part of this 
 treatise, a case reported by Dr. Maty, in which impairment 
 of speech was one of the symptoms of spinal disease, and 
 Abercrombie* has related three cases in which lesion of 
 speech was accompanied by spinal symptoms; in the first 
 of these there was found after death suppuration between 
 the cord and its membranes, the brain being perfectly 
 healthy ; in the second case, no disease whatever was 
 found either in the brain or spinal cord, or in the bones 
 of the spine, although the symptoms during life were 
 
 * "On Disease of the Brain and Spinal Cord," pp. 333, 356, 410. 
 
120 APHASIA, OR LOSS OF SPEECH. 
 
 those ordinarily indicative of spinal disease ; in the third 
 case there was undefined suppuration of the cord. 
 
 Case V. — Ataxic Aphasia occurring as a 
 Climacteric symptom. 
 
 Anna Maria Moore, aged 47, a labourer's wife, of a strongly- 
 marked nervous temperament, came under my observation as an 
 out-patient of the hospital on November 9th, 1867. 
 
 She was the mother of ten children, and miscarried two years 
 previously, had never enjoyed her usual health since, and men- 
 struation from that time had always been irregular and too frequent, 
 and she felt a constant pain in the lower part of the back. 
 
 In February she had a severe sore throat, with ulceration of the 
 tongue and of the mucous membrane of the cheek ; and during 
 this attack she lost the power of speaking for three days. Her 
 speech continued all right till June, when the throat became 
 similarly affected as in February, but to a less extent, and she 
 again lost her speech. This time, however, the defect was not of 
 a transitory character, as on the former occasion, for it continued 
 up to the time of her admission into the out-patient department of 
 the hospital. 
 
 On my asking her what ailed her, she could not make herself 
 understood ; she seemed, however, to understand perfectly what I 
 said to her; and there was an attempt to talk, resulting in a 
 nervous, unintelligible stutter. She seemed to have the proper 
 use of her tongue, which was protruded straight ; deglutition and 
 phonation were unimpaired ; there was no paralysis of limbs, 
 nor abnormal sensation in the same. At the expiration of a week, 
 finding there was no return of the power of speech, she became an 
 in-patient in the hospital. 
 
 November nth (two days after admission). — At my visit to-day, 
 to my astonishment, she addressed me quite naturally. On making 
 inquiries, I ascertained that when first admitted into the ward no- 
 body could understand her ; on getting up the next day she found 
 she could speak better ; the improvement continued during the 
 day, and this morning she speaks as well as ever. 
 
author's OWN CASES. 12 [ 
 
 November iyd. — No return of her inability to speak having 
 occurred, she was this day made out-patient. 
 
 1886. July \st. — Presented herself at the hospital to-day. The 
 speech is impaired; she is, however, menstruating, and she says 
 her speech is always more embarrassed at the period of menstrua- 
 tion. 
 
 June 29th. — Speech very bad to-day ; can only express herself 
 with the greatest difficulty. Menstruation, which should have 
 begun some days since, has not yet occurred. 
 
 February \2tI1. — Menstruation still deferred. For a period of 
 three days, since her last visit, she could scarcely speak at all. 
 
 Without dwelling on the further details of this case, I would 
 merely observe that the urinary secretion varied considerably in 
 quantity, and she seldom passed a fortnight without what she called 
 "a stoppage" — evidently an attack of painful micturition, with 
 partial suppression. It seemed desirable to make a volumetric 
 analysis of the urine, which gave the following result as to the 
 principal solid ingredients : — 
 
 Chlorides - - 7 parts per 1,000 
 
 Urea - - 19 „ 
 
 Phosphoric acid in combination - 1.8 „ 
 
 Quantity passed in 24 hours 35 pints, sp. gr. 1020, freely acid, no 
 albumen. In reference to the treatment of this case, I found 
 diffusive stimulants of service, and she subsequently derived con- 
 siderable benefit from the bromide of potassium. 
 
 On analysing this patient's symptoms, it is clear that 
 the defect of the speech was ataxic, for no amount of 
 prompting could assist her in the least ; there was no 
 amnesia. What was wanted was not the word, but the 
 recollection of the process by which to give it utterance. 
 
 I do not apprehend that the faculty of language was 
 impaired in its intimate seat, for she was in no wise 
 deprived of ideas necessary to serve as a pabulum for 
 language, but there was suspension of the power of co- 
 
122 APHASIA, OR LOSS OF SPEECH. 
 
 ordination necessary to the production of speech. I 
 presume the embarrassment of speech was due to what 
 M. Auguste Voisin* calls, ll V interruption plus oil moins 
 complete de Vincitation volontaire" or, to use the words 
 of Todd, " There did not exist that relation between the 
 centre of volition and that of intellectual action which is 
 necessary to give expression to the thoughts in suitable 
 language ; the centre of intellectual action had full 
 power to frame the thoughts, but as the will was not 
 prompted to a certain mode of sustained action, the 
 organs of speech could not be properly brought into 
 play." 
 
 The fact of the dysphasia being aggravated at the 
 menstrual periods is worthy of notice. It first occurred 
 after a menorrhagic flux, and the whole morbid chain 
 of symptoms may be considered as climacteric. M. 
 Delasiauve has cited the case of a lady who for three 
 years, at each menstrual period, was affected with mutism 
 and partial paraplegia, being at those times only able to 
 make herself understood by signs. f 
 
 Another interesting feature in this case to which I 
 would call attention, without, however, drawing any 
 inference from it, is — that the lesion of speech first 
 occurred after a severe attack of sore throat. I regret I 
 have not been able to ascertain whether the throat affec- 
 tion was of a diphtheritic character, but the coincidence 
 of the two symptoms is deserving of notice. 
 
 It may, perhaps, be said that cases like the above are 
 
 * This accomplished alienist physician, to whom I am much indebted 
 for great personal courtesy during a recent visit to La Salpetriere, is the 
 author of an excellent article on Aphasia in "Le Nouveau Dictionnaire de 
 Medecine et de Chirurgie Pratique." 
 
 t "Journal de Medecine Mentale," 1865. 
 
author's own cases. 123 
 
 common enough ; possibly they are, but their study is 
 not the less interesting on that account ; and here I 
 would ask what was the ultimate cause of the symptoms 
 observed in this patient ? I have heard the term nervous- 
 ness applied to such cases, but this word throws no light 
 on their pathology. Nervousness, like hysteria, is a 
 word frequently used as a cloak to our ignorance. 
 
 Is it not possible that the abnormal symptoms might 
 be due to some form of uraemic poisoning? There were 
 two circumstances rather favouring this view — viz., the 
 partial retention of a fluid which had for years been 
 periodically thrown off, and the frequent partial suppres- 
 sion of the urinary secretion. In reference to this latter 
 hypothesis, it is true that the volumetric analysis of the 
 urine (made at the time when the secretion was in its 
 normal quantity) did not disclose a predominance of any 
 particular ingredient ; still, I cannot help thinking that 
 in this and similar cases, where the symptoms are inter- 
 mittent, they may be due to some element in the blood 
 which has a deleterious effect upon the cerebral circu- 
 lation. 
 
 It will be observed that there is no abolition of a 
 faculty in such cases as the above, but simply an obstacle 
 to the manifestation of such faculty. The faculty of 
 language is present, but one of the processes is wanting 
 by which it is brought into communication with the 
 external world. 
 
124 APHASIA, OR LOSS OF SPEECH. 
 
 Case VII. — Left Hemiplegia with Aphasia; 
 No disease of Frontal Convolutions ; Exten- 
 sive disease of right hemisphere; Vegetations 
 on aortic and mitral valves ; fibrinous blocks 
 in the Spleen. 
 
 William Lemon, a gasfitter, aged 40, was admitted into the 
 Norfolk and Norwich Hospital on January 4th, 1868, with the 
 following history : — He had been ailing more or less since Mid- 
 summer, but had been able to continue his work till early in 
 November. A fortnight later he was suddenly seized with left 
 hemiplegia, and considerable embarrassment of speech, to such an 
 extent that a stranger could not understand him at all. His power 
 of speech gradually improved, and at the end of a fortnight he 
 could speak nearly as well as usual. 
 
 Condition on admission. — There is complete motor paralysis of 
 left leg and arm ; anaesthesia only partial, if any. He has no pain 
 or abnormal sensation in the head, the organs of special sense are 
 unimpaired, and there now remains but very slight embarrassment 
 in his speech. There is a well-marked double bruit heard nearly 
 all over the anterior part of the chest, but at its maximum intensity 
 at the apex, the diastolic murmur being the most marked. Pulse 
 84, quite steady and regular, but very hard, sharp, and almost 
 dicrotic. Urine, sp. gr. 1023, freely acid, slightly albuminous, and 
 loaded with lithates. 
 
 January iSt/t. — This patient continued much the same as on 
 admission up to 6 p.m. yesterday, when the nurse, on taking him 
 his tea, noticed he had lost the power of articulation, although he 
 seemed to know all that was going on ; a few minutes before the 
 power of speech was lost he spoke a few words, implying that he 
 saw imaginary beings around his bed. The power of articulation 
 was never recovered, and he soon became comatose, and died early 
 this morning. 
 
 Autopsy. — Heart: weight 19 oz.; right ventricle contained 
 coloured and decolorised clots extending just beyond the pulmonary 
 
author's own cases. 125 
 
 valves ; right auriculo-ventricular orifice admitted four fingers and 
 a thumb ; tricuspid valves healthy ; walls of left ventricle immensely 
 hypertrophied ; dilatation of left auriculo-ventricular orifice; the 
 mitral and aortic valves were both covered with fibrinous vegeta- 
 tions, apparently recent ; there was commencing atheroma to the 
 extent of an inch and three-quarters at the origin of the aorta. 
 
 The Lungs were healthy. 
 
 Liver : weight 4 lbs. 2 oz., healthy. 
 
 Spleen : very soft and friable, contained several fibrinous blocks 
 which appeared as white elevated patches on the surface, and on 
 section were seen to be of the size of large walnuts, of a yellowish- 
 white appearance, and of a waxy consistence, 
 
 Kidneys : the right weighed 1 1^ oz., the left 8 oz., both in a state 
 of intense congestion. 
 
 Brain : stripped of dura mater, it weighed 3 lbs. 3^ oz. ; there 
 was no abnormal vascularity or other morbid appearance, either on 
 its convex surface or at the base. There was a general flattening 
 of the superior surface of the right hemisphere, which was some- 
 what less developed than the left, and its convolutions were shrunk. 
 The brain was carefully sliced, and no abnormal appearance dis- 
 closed until opening the lateral ventricles, when a yellow stain was 
 seen on the upper portion of the right corpus striatum ; on a level 
 with this body, but behind, and external to it — at about the middle 
 third of the hemisphere — was a softened portion of about the size 
 and shape of a large walnut ; there was also slight softening of the 
 thalamus at its posterior part. On cutting into the corpus striatum, 
 it was seen that the posterior two-thirds had undergone the soften- 
 ing process, being of a yellowish hue, and of a waxy consistency. 
 Antero-posterior slices were made in both anterior lobes, but no 
 morbid change revealed ; the frontal convolutions were examined 
 with great care, and the right and left convolutions compared, but 
 they seemed perfectly healthy ; but as the softening of the right 
 hemisphere approached so near the surface of the right side — cer- 
 tainly within half an inch of Broca's region— it is quite possible 
 that some slight alteration of the posterior part of the frontal con- 
 volutions may have existed, not patent to our means of investigation. 
 The vertebral and basilar arteries were healthy, as also the ter- 
 mination of the carotids. There was no obstruction of the middle 
 cerebral arteries, but that on the right side, when traced along the 
 
126 APHASIA, OR LOSS OF SPEECH. 
 
 fissure of Sylvius, presented at the point of its first bifurcation a 
 milky appearance, to the extent of about a quarter of an inch in 
 length. The olivary bodies were specially examined, and were 
 quite healthy, f as were also the medulla oblongata, cerebellum, pons, 
 and crura cerebri. 
 
 Microscopic Examination. — A separate examination was made of 
 the corpus striatum, and also of the softened hemisphere. In the 
 corpus striatum there was no proper brain structure ; an absence 
 of vessels and nerve fibres ; an abundance of granular matter. In 
 the porton taken from the hemisphere there was an absence of 
 nerve fibres, and the vessels were coloured with fawnish pigment ; 
 there was an abundance of granular matter, with here and there a 
 fat globule. 
 
 The above case is extremely interesting from several 
 points of view. In the first place, I would observe that 
 the cardiac disease was doubtless the primary cause of 
 the softening of the cerebral tissue ; and it is extremely 
 probable that some vegetations, similar to those ob- 
 served on the aortic and mitral valves, had become 
 detached, and thus had been carried into one or more of 
 the cerebral vessels, although no positive evidence of 
 obstruction existed after death. 
 
 The condition of the spleen is confirmatory of this 
 view, as the fibrinous blocks found in that organ un- 
 doubtedly betokened an obstruction to the splenic cir- 
 culation similar to that which had probably produced 
 the cerebral symptoms. It would seem that these 
 fibrinous deposits in the spleen have been frequently 
 observed in the autopsies of aphasic patients. In four 
 of Dr. Win. Ogle's cases, this condition of spleen was 
 observed ; and in each case, as in that of Lemon, there 
 was also disease of the heart. 
 
 If the above observation is in direct antagonism to 
 M. Dax's theory of the localisation of speech in the left 
 
author's own cases. 127 
 
 hemisphere, it is a fortiori opposed to that of Professor 
 Broca ; for although the softening was suspiciously near 
 the third frontal convolution of the right side, the left 
 frontal convolutions, as indeed the entire left hemisphere, 
 presented no trace of disease whatever. 
 
 It will be observed that the lesion of speech was 
 associated with paralysis of the left side. This coin- 
 cidence of aphasia with left hemiplegia is, I believe, 
 much more common than is generally supposed ; I have 
 met with it several times in my own practice, and 
 I have already, in the preceding pages, mentioned cases 
 where this combination of symptoms was observed. 
 Sir Crichton Browne has informed me that he has 
 collected six cases of left hemiplegia with aphasia, which 
 I trust he may be induced to place on record. With 
 this accumulation of evidence, I am astounded to read in 
 Huguenins' article in " Ziemssen's Cyclopedia," that "in 
 general, no case of aphasia following injury or disease of 
 the right side of the brain has come under our notice." 
 The relation between right hemiplegia and aphasia, al- 
 though a tolerably constant one, is by no means 
 absolute.* 
 
 * Whilst this is passing through the press, my attention has been called 
 to a case reported by Professor Michel Catsaras of Athens, the subject of 
 which was a man who had several slight apoplectic seizures with left 
 hemiplegia and aphasia, which in each instance soon passed off; the 
 patient, however, ultimately had an attack of apoplexy of a more serious 
 and definite type, and remained permanently hemiplegic on the left side. 
 As this man was right-handed, it was suggested, by way of explanation, 
 that in his case the anterior pyramids may not have decussated. " La 
 France Medicale," 1884, No. 83. 
 
128 APHASIA, OR LOSS OF SPEECH. 
 
 Case VIII. — Loss of Speech of an inter- 
 mittent CHARACTER, PRECEDED BY NUMBNESS OF 
 
 tongue; Lingual Spasm; Fatal termination, 
 with symptoms of bulbar paralysis. 
 
 Walter Hare, an artisan, aged 28, came under my observation as 
 an out-patient of the Norfolk and Norwich Hospital, on October 
 12th, 1872, with the following antecedent history. He had been 
 married five years, and had three children ; had never had syphilis, 
 but was an inveterate smoker. 
 
 He had always enjoyed good health till about nine months before, 
 when, whilst engaged in his ordinary employment, and without any 
 apparent cause, he was seized with giddiness, the room seemed to 
 him to be working round with him ; he was obliged to discontinue 
 his work and walked home with difficulty, reeling from one side of 
 the. pavement to the other, in such a manner as to lead the by- 
 standers to think he was drunk. 
 
 The feeling of giddiness, which was at this time the only 
 symptom, lasted for about a month, when he was able to resume 
 his work, and he remained quite well for about half a year, when, 
 whilst at work, he was seized with numbness in the tongue, and 
 this sensation occurred several times daily, lasting for about half 
 an hour. 
 
 This peculiar affection of the tongue continued as the only 
 morbid symptom till about a month before he came to the hospital, 
 when, whilst taking a meal, the habitual numbness came on, and 
 when it had lasted two or three minutes, his speech quite left him, 
 and, to use his own expression, he was like a dumb man. He had 
 just before informed his wife that the numbness had commenced, 
 and in answer to her inquiry whether he was getting better, he 
 shook his head, and was unable to say " no ; " in fact, he could not 
 utter a single word, and was absolutely speechless. This inability 
 to speak, together with the numbness, lasted three-quarters of an. 
 hour, when they both left him at the same time, and he could speak 
 as well as ever. 
 
 The above combination of symptoms recurred at intervals, and 
 
author's own cases. 129 
 
 he was in such a constant state of uncertainty as to whether his 
 speech would leave him or not, that when sent by his master on an 
 errand to a shop, he was in the habit of writing down what he 
 wanted to purchase, for fear that the aphasia might come on, and 
 that he should not be able to say what he wanted. 
 
 Whilst conversing with me, he said that the numbness in the 
 tongue had just come on, but, as yet, he was able to speak. I 
 asked him to protrude the tongue, which he was able to do straightly 
 and completely. I pricked the tongue with a pin, and he said he 
 did not feel it. In a few minutes the numbness left him, and he 
 said it was passing down his right side— that he felt a numbness in 
 the right arm, right side of the body, and right leg. This perverted 
 sensation lasted about two minutes, the arm recovering first, then 
 the side, and lastly the leg. 
 
 In answer to my inquiry, he told me that when the fits of " dumb- 
 ness" come on, "his tongue is not set fast," he can move it in his 
 mouth in all directions, but the protruding power is interfered with, 
 as he can only protrude it half its usual length. 
 
 November 16th. — No particular change occurred in this man's 
 condition until to-day, when the habitual numbness in the tongue 
 began, his speech became very indistinct, he became dizzy, and 
 fell down insensible, remaining unconscious for half an hour. 
 
 January 1st, 1873. — For several days past he has had frontal 
 headache, and noises in the ears. 
 
 February $th. — The patient has an anxious expression, and the 
 face is a little swollen ; he seems somewhat stupid in his manner, 
 and is a little deaf; at all events, he does not catch what is said as 
 readily as formerly. He now expresses himself with some difficulty, 
 and says that since his fall in November the power of speech has 
 been permanently affected, whereas before this accident, when the 
 aphasia was not present, his speech was as fluent and easy as 
 possible. The tongue is protruded without difficulty, but decidedly 
 to the left side. He has less power in the right leg, in which there 
 is decidedly less sensation, and his gait is somewhat affected. 
 
 April 2nd. — Has now constant pains in the left temple, his 
 cheeks are very much swollen from flaccidity of the muscles, has 
 difficulty in swallowing fluids, which he says he "cannot get 
 rid of." 
 
130 APHASIA, OR LOSS OF SPEECH. 
 
 I will not enter into details about the further progress of this 
 case ; he soon discontinued his attendance at the hospital, and I 
 lost sight of him, but I have reason to believe that he ultimately 
 died with all the symptoms of Bulbar Paralysis. 
 
 In commenting upon the peculiarities of this case, I 
 would call attention to the complete absence, at all 
 events in the first instance, of any symptom pointing to 
 hemispheric disease. It is true that eventually there 
 was slight impairment both of motion and of sensation 
 in the right leg, but this only occurred as a late symptom. 
 
 As far as the function of speech was concerned, it 
 seems to have been a mere affection of the articulation — 
 what Kussmaul calls anarthria — the result of paralysis 
 and atrophy of the muscles necessary for articulate 
 speech, probably dependent upon lesion of the centres or 
 nuclei of the hypoglossal, facial, spinal accessory, and 
 glosso-pharyngeal nerves, which have undergone the 
 degenerative process. 
 
 In the peculiar disorder lately described as Thomsen's 
 disease, which is characterised by spasmodic rigidity of 
 certain voluntary muscles, the tongue is said to be 
 usually involved, and the peculiarity of the spasm is its 
 transitory and initial character, occurring at the very 
 moment of executing a movement, or rather during the 
 execution of a movement; the muscular spasm also is 
 devoid of that painful character which appertains usually 
 to cramps in healthy individuals. It will be observed 
 that the early symptoms in Hare's case resembled in 
 some respects those observed in Thomsen's disease.* 
 
 * In the "Archives de Neurologie " for January, 1883, is an essay by 
 Ballet and Marie, entitled " Spasme Musculaire au debut des Mouvements 
 Volontaires," which the authors characterise as a functional trouble not 
 
author's own cases. 131 
 
 Case IX. — Loss of Speech occurring as a 
 Puerperal symptom ; Lacteal derangement ; 
 Right Hemiplegia ; Fatal termination. 
 
 On September 7th, 1886, I was requested to see, in consultation 
 with Dr. Watson, of Norwich, Mrs. S., aged 23, who had given 
 birth to her second child eight days previous to my visit. 
 
 Upon inquiry, I ascertained that she had never been the subject 
 of any cardiac or rheumatic affection, that she had never suffered 
 from any nervous disorder, and, in fact, that she had always enjoyed 
 good health during her single life, with the exception of a disposition 
 to occasional headaches. Her mother was insane and died in the 
 Norwich City Asylum, but beyond this fact there was no neurotic 
 tendency in the family. 
 
 She was delivered of her first child in July, 1885, and at the 
 seventh month of this her first pregnancy, she had some obscure 
 mental symptoms with some embarrassment of speech, which lasted 
 about a month. Her first confinement passed off quite naturally, 
 and she nursed her child for nine months, at first with both breasts, 
 but in one breast (it is believed to have been the left) there was 
 galactorrhcea for some weeks, and then the supply ceased entirely in 
 this mamma. 
 
 hitherto described in France. The chain of symptoms enumerated are 
 those of Thomsen's disease, and a case is cited in some respects similar to 
 Hare's, in which the authors say there was " une gene assez prononcee des 
 mouvements de la langue, semblant sieger surtout vers la racine de celle-ci, 
 gene toute passagere d'ailleurs, et ne survenant que de temps en temps." 
 In this most interesting and highly original essay, the authors object to the 
 term "pseudo-hypertrophic paralysis" which has been applied by some 
 German writers to this type of disease, as they say that its hypertrophic 
 element is doubtful. In the same journal for November, 1884, Dr. Romain 
 Vigouroux publishes a case in which the symptoms of Thomsen's disease 
 co-existed with those of pseudo-hypertrophic paralysis. I recommend the 
 perusal of both these valuable articles to all those who are interested in 
 obscure points of nervous pathology. 
 
132 APHASIA, OR LOSS OF SPEECH. 
 
 Mrs. S. continued quite well till three months before her second 
 confinement, when a gradual loss of power occurred in the right 
 arm and leg, but principally in the arm ; a month before her con- 
 finement, embarrassment of speech was noticed, which'culminated 
 in complete aphasia six days after delivery, which was quite natural, 
 and unattended by any straining or unusual effort ; there was no 
 haemorrhage, and the lochia were quite natural, The total loss of 
 speech was sudden, for on the evening of the fifth day, although 
 her speech was embarrassed, she could converse and make herself 
 understood, but on the morning of the sixth day it was observed 
 that she was completely aphasic ; there was no loss of conscious- 
 ness, and her general appearance was as usual, the only difference 
 being the total suspension of the power of articulate language. 
 This sudden exasperation of her symptoms could be attributed to 
 no apparent cause ; she had not been exposed to any mental shock 
 or disturbance of any kind, but a thunder storm of very unusual 
 severity occurred the evening before. 
 
 On the second day after delivery, there was a sudden tumes- 
 cence of the breasts with an unusual quantity of milk, the lacteal 
 secretion being so abundant that, although the child sucked 
 vigorously, the milk had to be removed artificially ; the supply was 
 equal on both sides. This lacteal overflow was but of short 
 duration, for the next day the quantity diminished perceptibly, and 
 "on the fifth day the child had to be weaned because the supply 
 was gone. 
 
 At my visit on the eighth day after parturition, I found her 
 with right hemiplegia and aphasia, and I observed that she was 
 "unable to protrude the tongue. There was no pyrexia, the tem- 
 perature was normal ; the pulse was 74, and there was no cardiac 
 trouble of any kind ; there was no pain or swelling of the body, 
 and no abdominal or pelvic complication whatever ; there was, 
 however, retention of urine, but nothing abnormal in the secretion 
 itself. 
 
 Although unable to speak, she evidently understood all that was 
 said, and seemed annoyed and became angry when too many 
 questions were put to her ; and to every question, whatever it might 
 be, she invariably said " The other day." I asked her how many 
 children she had ; she replied, " The other day." I then asked her 
 
PUERPERAL APHASIA. 1 33 
 
 what she had for her breakfast ; she replied " The other day." She 
 could say nothing else, and this recurring utterance, whether appro- 
 priate or not, she repeated on all occasions ; it was a stock phrase 
 with her, and of course had no intellectual value. 
 
 Without developing any fresh symptom, Mrs. S. gradually be- 
 came weaker, and sank from exhaustion six weeks after her con- 
 finement ; and within an hour of her death, in answer to an inquiry 
 as to how she felt, she replied, " The other day," which was the 
 only phrase she had uttered since the commencement of her 
 attack. 
 
 The above case is interesting from the association of 
 aphasia with the puerperal condition. Hemiplegia is not 
 an uncommon symptom connected with pregnancy and 
 childbirth. Churchill has recorded 22 cases of paralysis 
 during pregnancy collected by him from various sources, 
 but although difficulty of articulation may have been 
 noticed in some of these cases, it was probably simply 
 due to paralysis of the tongue and the muscles which are 
 concerned in the articulation of words, without any real 
 disturbance of the faculty of language. 
 
 One of the leading obstetricians of London, to whom 
 I communicated the details of the above clinical history, 
 informs me that he has never met with a similar case ; 
 and amongst 8,000 cases of midwifery recorded by a 
 French authority, M. Sireday, not a single instance of 
 the coincidence of aphasia with the puerperal condition 
 is mentioned ; in fact, this combination does not find a 
 place in our classical treatises of midwifery, and the only 
 case that I have met with in my reading is one recorded 
 by Dr. Leith Napier, the subject of it being a lady, who, 
 seventeen days after her confinement, on being subjected 
 to. considerable vexation, suddenly became speechless; 
 this was followed in three days by partial paralysis, 
 
134 APHASIA, OR LOSS OF SPEECH. 
 
 which culminated in complete hemiplegia two days 
 later. Dr. Napier attributed the above symptoms to 
 occlusion of the left middle cerebral artery from embolism. 
 The patient slowly improved, and eventually recovered.* 
 It is only quite recently that prominent attention has 
 been called to the association of aphasia with the puer- 
 peral condition, by a most interesting and exhaustive 
 article by M. Poupon in " L'Encephale" for July, 1885. 
 This important communication is based upon a case 
 observed by the author at La Charite, in the ward of 
 Professor Laboulbene. The subject of it was a woman, 
 aged 24, Julie M., who on the second day after a per- 
 fectly natural delivery, was seized with right hemiplegia 
 and aphasia, her vocabulary (as in my own case) being 
 limited to three or four words in answer to all questions, 
 the expressions used being, "eh bien," "oui, oui," "mais 
 j'ai mais." This patient is described as having had an 
 attack of articular rheumatism some years before, and 
 as there was hypertrophy of the heart with mitral dis- 
 ease, the author makes the diagnosis of embolism of the 
 left middle cerebral artery, due to a mitral constriction, 
 upon which was superadded an endocarditis, caused by 
 her puerperal condition ; he explains the fact of the 
 sudden occurrence of the symptoms of embolism on the 
 third day, by the hypothesis that the embolus might 
 have been nearly detached during the labour, but that a 
 fresh effort was necessary to complete its separation ; 
 and as she was suddenly taken speechless whilst at a 
 meal, he thinks the change from the recumbent to the 
 
 * Puerperal Embolism — Aphasia — Hemiplegia — Recovery. By A. D. 
 Leith Napier, M.B., "Edinburgh Medical Journal," Sept., 1877, p. 222. 
 
PUERPERAL APHASIA. I 35 
 
 sitting posture may have been sufficient to complete the 
 detachment of the embolus. 
 
 M. Poupon enters at considerable length into the 
 pathology of the above case, and also gives a short 
 analysis of others that have fallen under his notice, in 
 two of which he says there was an evident relation 
 between the lacteal secretion and the appearance of the 
 aphasia ; in one instance, however, the lacteal disturbance 
 preceded the cerebral accidents, and in the other it 
 followed them ; in the latter case (which was one of 
 exceptional interest from the fact of the subject being 
 left-handed, and the paralysis being on the left side) it 
 is stated that from the moment the left hemiplegia and 
 aphasia were observed, the lacteal secretion ceased in the 
 right breast, whilst in the left (the paralysed side) it 
 appeared to increase, and was much more abundant 
 than usual. According to the statement of the patient, 
 the temperature of the left or paralysed side as well as 
 that of the corresponding breast, was higher than on the 
 right side ; the perspiration was also much more copious 
 on the left than on the right side. 
 
 In commenting upon this last observation, M. Poupon 
 calls attention to the increase of the lacteal secretion 
 under the influence of the paralysis, and he considers the 
 pathological condition was probably vaso-motor paralysis 
 of the breast, resulting in a dilatation of the vessels and 
 a more abundant secretion of milk.* 
 
 On reviewing the symptoms manifested by the patient 
 whose clinical history I have described, it will be noted 
 that Mrs. S. never had any rheumatic affection or 
 
 * " Des Aphasies Puerperales," par H. Poupon. " L'Encephale," No. 
 4, 1885, p. 393. I shall have occasion again to refer to this original com- 
 munication in a subsequent chapter. 
 
136 APHASIA, OR LOSS OF SPEECH. 
 
 cardiac complication of any kind ; the labour was quite 
 natural, and there was no feature in her condition to 
 suggest the idea of septicaemia or of blood dyscrasia. 
 
 The only unusual symptom was anomalous lactation, 
 for it will be remembered there was great turgescence 
 of the mammae, and an excessive flow of milk — quite a 
 galactorrhcea for 24 hours — and then a somewhat sud- 
 den disappearance of the secretion. 
 
 From the comparative rarity of the association of loss 
 of speech with the puerperal state, I hesitate to venture 
 upon any decided opinion as to the pathology of the 
 above case. The symptoms could scarcely be due to 
 any merely transient cause, for they had existed in a 
 modified form for three months before parturition, and 
 became intensified a few days after labour ; the absence 
 of any cardiac lesion, and the gradual development of 
 the nervous symptoms would rather point to cerebral 
 thrombosis than to embolism. 
 
 Case X. — Intermittent Aphasia ; Epileptic 
 
 LOGONEUROSIS ; PECULIAR FORM OF AURA j GOOD 
 EFFECTS OF ELECTRICITY ; RECOVERY. 
 
 R. Dalliston, a miller's servant, aged 27, a total abstainer, was 
 admitted under my care into the Norfolk and Norwich Hospital 
 on May 3rd, 1884, with the following antecedent history. 
 
 There was no hereditary tendency to neurotic disease ; a sister 
 had been the subject of hysteria, but beyond this circumstance 
 his family history was quite of a negative character. He was 
 better educated than most men of his class, and was very fond of 
 reading ; he had always been extremely temperate in his habits, 
 and for some years past had been a total abstainer ; he had never 
 contracted syphilis, and had always enjoyed the most robust 
 
author's own cases. 137 
 
 health till December, 1879, (20 months after marriage,) when he 
 was suddenly seized with pain at the back of the head and down 
 the nape of the neck ; the pain was so severe that he rushed out of 
 his house, and ran about in such an excited manner and was so 
 violent as to lead the bystanders to think he was mad. 
 
 When shortly afterwards he was seen by his medical attendant, 
 Mr. Long, of Wells, he was more composed, and intimated by 
 signs that he had pain in the head, but it was observed that he was 
 absolutely speechless. As there was no paralysis of any kind, 
 Mr. Long was puzzled at his symptoms, and told me that if the 
 subject of them had been a female, he should have considered her 
 as under the influence of violent hysteria ; Mr. Long added that 
 there was "a sort of unreality about the patient." He was treated 
 by bromide of potassium, which seems to have relieved him, but the 
 loss of speech lasted four days, when it suddenly returned, and he 
 was able to resume his usual employment. 
 
 Four years now elapsed, during which time he continued in per- 
 fect health, and evincing no psychical anomaly of any kind, when 
 about five weeks before his admission to the hospital, on leaving 
 the mill one evening, he complained of a feeling "as if a fit were 
 coming on ; " he was then seized with pain at the back of the head, 
 and became so outrageous that it required two strong men to conduct 
 him home, as he struggled so violently. On reaching his house 
 he seemed beside himself, and even threatened his children, who 
 had to be put out of the way. On the arrival of Mr. Long, he had 
 become quiet, but was totally speechless ; he pointed to his head, 
 and was quite rational. As at the end of five weeks there was 
 no return of the power of speech, he was removed to the hospital. 
 
 Condition on admission. — The patient has the appearance of 
 robust health, seems very intelligent, and presents no other abnor- 
 mal appearance whatever but complete loss of the power of 
 articulate language, the inability to speak having this time lasted 
 five weeks, with the exception of an interval of two hours, eight 
 days ago. 
 
 Although there is complete suspension of the faculty of articulate 
 language, the general faculty of language is unimpaired, as he is able 
 to describe all his symptoms in writing and also by dactylology, as 
 
I38 APHASIA, OR LOSS OF SPEECH. 
 
 it so happens that both he and the house surgeon's assistant under- 
 stand the deaf and dumb alphabet, and thus hold conversation 
 with each other. 
 
 He can phonate, and there is no paralysis of the lips, facial 
 muscles, palate, or tongue ; these organs for all purposes but 
 speech, are completely under control. His intellect is clear, the 
 idea is present, the words are not wanting, but articulation is not 
 at the service of the words. That he is clearly in possession of the 
 acoustic word-signs is evident from the fact that he can translate 
 the same into writing. He was ordered bromide of sodium, gr. xv., 
 three times a day. 
 
 May 1 2th. At my visit this morning, nine days after his ad- 
 mission, I find he can converse freely, the power of speech having 
 returned at 7.40 a.m., after an absence of six weeks and two days. 
 
 He gives the following very curious account of the advent and 
 the departure of the aphasia, both of which are heralded by what 
 he calls "fits," distinguishing them by the respective names of 
 " silent fits" and " talking Jits.' 1 '' On being asked to describe these 
 attacks, he says that the silent fit is preceded by intense heat at 
 the nucha, then follows agonising pain at the same spot, he feels 
 " as if several balls ran from his loins to his neck," causing a feeling 
 as if something had exploded, and then his speech leaves him ; the 
 loss of speech is preceded by convulsive twitchings of the muscles 
 at the back of the neck, apparently of an epileptoid character, and 
 accompanied by much pain. 
 
 i^t/i. The power of speech recovered yesterday lasted only 
 fourteen hours, for early this morning the pain in the neck, peculiar 
 to what he calls his silent fit, came on, and he became speechless. 
 The interrupted current was applied to the nape of the neck and to 
 the tongue, with the hope of restoring speech, but with no beneficial 
 result. 
 
 14.1/t. Speech still absent, the power of phonation is also nearly 
 entirely abolished to-day ; he is unable to make a noise in his 
 throat by singing or otherwise, and can produce nothing beyond a 
 feeble and nearly inaudible grunt. 
 
 His muscular strength as tested by the dynamometer disclosed a 
 marked difference on the two sides, the grasp of the right hand 
 showing a pressure of fifteen kilogrammes as against thirty-three 
 kilogrammes in the left. 
 
EPILEPTIC LOGONEUROSIS. 139 
 
 16//?. At my visit to-day, I find he can talk freely, the aphasia 
 having lasted this time three days. He informs me that at 
 3.45 a.m. pains in the back began (talking fit), which increased in 
 intensity till 5.30, when he began to talk, indistinctly at first, but 
 at 7 o'clock could talk plainly. His voice to-day is more husky 
 than after the last recovery of speech ; he says that he has noticed 
 that each time speech returns, the voice gets hoarser in tone. 
 
 22nd. Speech lost suddenly to-day, having been preceded by 
 pain at the nucha of half-an-hour's duration. 
 
 26th. Faradic current applied at 9.30 p.m., in consequence of 
 the recurrence of the pain at the nucha ; the electricity relieved the 
 pain, which entirely subsided at 1 1 p.m. 
 
 28//Z. Pain in the back (talking fit) commenced at 5.30 a.m., 
 resulting at 6.30 in the recovery of speech, which he had lost for 
 six days. 
 
 30th. Pain at nucha (silent fit), followed by loss of speech ; 
 was faradised at once. 
 
 3U/. Speech returned to-day at 2 p.m., having been preceded 
 by pain in the back (talking fit). 
 
 June ^rd. Pain in the neck (silent fit) set in at 9 a.m. ; fara- 
 disation was applied immediately; the pain subsided in an hour 
 and a half, without loss of speech. Mr. Kempster, the house 
 surgeon's assistant, says he has remarked that if the battery is 
 applied before the aphasia occurs, the power of speech is retained. 
 The patient himself has the greatest confidence in the battery, 
 and says "it eases my pain, and retains my speech." 
 
 \th. The urine on examination being found loaded with oxalates, 
 a mixture containing Nitro-Hydrochloric acid and infusion of 
 gentian was prescribed. 
 
 At 4.30 p.m., whilst in the chapel, he was seized with pain at the 
 nucha, followed by loss of speech. 
 
 8//z. Speech returned, its restoration being preceded by the 
 usual pains in the back. A shower-bath was ordered to be given 
 daily. 
 
 nth. Pain in the neck at 7.45 p.m. ; loss of speech at 8 30. 
 16th. After the shower-bath at 7.20 p.m., the pain in the back 
 set in, followed by the recovery of speech at 8.30, after an absence 
 of five days. 
 
140 APHASIA, OR LOSS OF SPEECH. 
 
 igf/i. Pain in the neck at 4 a.m., followed by loss of speech. 
 
 list. Speech restored at 10.30 p.m., having been preceded by 
 the usual pain in the back. 
 
 On asking the patient to explain his own views as to what takes 
 away his speech, he replied that he presumed it was the pain in the 
 neck ; he also added that he never had the pain in the back with- 
 out speech being restored. He said the pains of both kinds were 
 diminishing very much in severity. 
 
 28I/1. Speech left him at 4.40 a m., preceded by neck pain ; 
 restoration of speech at 3.30 p.m., after a slight pain in the back. 
 
 July yd. Speech continues all right ; he has not passed water 
 for 45^ hours. He says that there has been a difficulty in micturi- 
 tion for several months, and occasionally a retention of urine of 
 24 hours. He says when the speech is gone, he has less trouble 
 with his water ! 
 
 8th. I happened to be in the ward to-day at the beginning of a 
 so-called "silent fit" with the characteristic pain at the nucha ; I 
 had therefore the opportunity of noting its peculiarities. It is clearly 
 of an epileptic character. I observed marked rigid contraction of 
 the muscles at the back of the neck — in fact, clonic twitchings, 
 leaving after each convulsion a kind of tonic contraction. He 
 appeared to be in very great pain, and put his left hand to the 
 nucha, as if it gave him relief. The fit lasted rather less than an 
 hour, and then he said he only felt weak, especially on the right 
 side. 
 
 From this period he continued rapidly to improve, and was, in 
 a marked manner, benefited by faradisation ; he was discharged 
 cured after eleven weeks residence in the hospital. 
 
 The above case is one of exceptional interest, whether 
 regard be had to the unusual combination of symptoms 
 which it presents, or to the questions of diagnosis, 
 pathology, and treatment. 
 
 On analysing its clinical history, it will be seen that 
 the salient features were total loss of speech of an inter- 
 mittent character, lasting from a few hours to six weeks ; 
 the suspension of the faculty of articulate language 
 
PECULIAR FORMS OF EPILEPTIC AURA. 141 
 
 always coinciding with pain at the nape of the neck, 
 and its restoration being as invariably accompanied by 
 pain in the lumbar spine. The coincidence of pain in 
 the above localities with the abolition and the restoration 
 of speech respectively was so constant, that he described 
 the speech phenomena as the "silent fit" and the 
 "talking fit." 
 
 Before entering into the inquiry as to what was the 
 matter with this patient, or what was the cause of his 
 intermittent attacks of aphasia, I must for a moment 
 glance at the latest contributions to this branch of 
 neurology. 
 
 Not only have neuropathologists located speech in 
 a certain definite portion of the brain, but they have of 
 late endeavoured to localise the various psychical 
 elements which enter into the complicated machinery 
 of speech, maintaining that there is a certain functional 
 independence between the different territories of the 
 cerebral cortex. 
 
 In a former chapter I described Professor Charcot's 
 schematic diagram of the centres and tracks of articu- 
 late language ; Kussmaul of Strassburg,* Wernicke of 
 Breslau,f and Baginsky of Nordhausen| have also 
 framed diagrams of a similar character ; but as I prefer 
 that of M. Charcot, I will refer the reader to the detailed 
 description I have given of it at page 38, and assuming 
 for the moment that it contains, at least, the germ of 
 scientific truth, I will inquire what portion of the sup- 
 posed speech-track was affected in the case I am now 
 considering. 
 
 * "Die Storungen der Sprache.' 1 S. 182. 
 
 f "Der aphasische Symptomencomplex, eine psychologische Studie auf 
 anatomischer Basis." S. 34. 
 
 $ "Berliner klinische Wochenschrift," No. 37, 187 1. S. 441. 
 
142 APHASIA, OR LOSS OF SPEECH. 
 
 In order to gauge Dalliston's psychical condition by 
 M. Charcot's schema, I must first glance at the elements 
 that enter into the constitution of language, which are 
 as follows : — 
 
 There must be sounds or signs suggesting an idea, 
 and they must be transmitted to the sensorium by means 
 of the ear or of the eye. 
 
 The formation of an idea, probably in the grey corti- 
 cal substance of the brain. 
 
 There must be the memory of words or of signs 
 necessary to express this new-born idea. 
 
 There must be the power of co-ordinating the 
 movements necessary for the external manifestation of 
 language. 
 
 Bearing in mind the above conditions, in what part of 
 the speech-track did the impediment exist ? 
 
 1st. The ideational centre (I C) was evidently unim- 
 paired, as he retained all his intelligence, and it is clear 
 that ideas were produced as the result of impressions 
 made on the senses, ostensibly in the cellular net-work 
 of that portion of the cerebral cortex set apart for that 
 purpose. 
 
 2nd. The common auditive centre (C A C) was also 
 unimpaired, as his acoustic nerve transmitted outward 
 sounds to it. 
 
 3rd. The auditive centre for words (A C W) was 
 intact, as he had not only an intelligent perception 
 of what was said to him, but the " word-symbols " were 
 at hand, as shown by his ability to translate the same 
 into writing. He retained words in his memory as 
 acoustic signs, but was incapable of uttering them, al- 
 though his intellect was clear, and the movements of the 
 organs of articulation were free. 
 
AUTHORS OWN CASES. I43 
 
 4th. The part that was out of gear was the centre of 
 articulate language (C A L), for although his intellect 
 was clear, and he retained words in his memory as 
 sensory images and as symbols of thought, he was in- 
 capable of uttering them, and they could no longer be 
 enunciated as a motor combination of articulate sounds ; 
 he could phonate, the movements of the tongue were 
 free, and there was no paralysis of the lips, mouth, or 
 palate, which for all purposes except speech, were 
 completely under control ; his organs of articulation 
 were free to move, but did not respond to his mental 
 impulses to speak. The idea was present, the words 
 were not wanting, but articulation was not at the service 
 of the words, and he was totally unable to accomplish 
 the physico-psychical act of the expression of thought, 
 by which the latter is converted into articulate language. 
 
 Pathology. Was there or was there not any persistent 
 change in this patient's nervous centre ? The symptoma- 
 tology of the case could be accurately studied, but it 
 was not easy pathogenetically to refer the symptoms to 
 changes in the organic mechanism. 
 
 A superficial observer would at once say, " Oh ! it was 
 simply an exaggerated form of hysteria." Now, in the 
 first place, genuine hysteria is uncommon in men. Of 
 332 cases tabulated by Hammond, only three were 
 males ; moreover, Dalliston presented quite the reverse 
 of the hysterical diathesis ; there was no emotional dis- 
 turbance, no indisposition to exert the will, no hallucina- 
 tions or delusions ; his inability to speak did not depend 
 on want of perception or of intelligence, but on want of 
 the power to set in motion the complicated instrumen- 
 talities necessary for articulate language. 
 
 K 
 
144 APHASIA, OR LOSS OF SPEECH. 
 
 On analysing carefully all Dalliston's symptoms, I am 
 inclined to class his case amongst the numerous shades 
 of epileptiform attacks. It is true that some of the 
 symptoms of true epilepsy were wanting ; the convul- 
 sions were not those which characterise epilepsia gravior, 
 nor was there the loss of consciousness observed in that 
 type of the malady. 
 
 It will be observed that he had a distinct aura, charac- 
 terised by abnormal sensations in the cervical spine. 
 Gowers, in his admirable monograph, says that all his 
 cases with a spinal aura were epileptic* 
 
 It may be said that the uncontrollable acts of violence 
 and strange behaviour at the onset of the disease some 
 years ago, were those of automatism, and were hysteroid 
 in character; but the same want of control is observed as 
 a symptom of epileptic vertigo. Trousseau, in his ad- 
 mirable chapter on Apoplectiform Cerebral Congestion, 
 mentions such cases which he considers as instances of 
 irregular epileptic paroxysms, one of the most striking 
 being that of a French judge, who was president of a 
 
 * "Epilepsy and other Chronic Convulsive Diseases," p. 55, In the 
 same chapter, this accurate clinical observer, in describing the modes of 
 onset in epilepsy, wiites as follows : — " Inability to speak often accompanies 
 a fit which commences in, or early involves, the right side of the face. For 
 instance, a girl had minor seizures, which consisted in a sensation of 
 tingling in the right arm, which passed up to the angle of the mouth, and 
 then she became unable to speak for about five minutes. In left-handed 
 persons, the speech-centre is usually on the right side, and not on the left 
 side of the brain ; and the association just mentioned was well exemplified 
 by a left-handed man, who, at the age of thirty-one, became liable to fits, 
 which commenced by spasms in the left side of the face, spreading thence 
 to the left arm, with loss of consciousness. Inability to speak preceded 
 each attack for ten minutes, and persisted afterwards for the same time. 
 Some of these cases are accompanied by a simultaneous sensation in the 
 tongue." 
 
author's own cases. 145 
 
 court of justice, and who was subject to fits of epileptic 
 vertigo. On one occasion, whilst presiding in court, he 
 got up all on a sudden, and went into the ante-room. 
 The usher of the court followed him, and saw him make 
 water in a corner of the room ; a few minutes afterwards 
 he returned to his seat, and listened with intelligence to 
 the pleadings of the advocate, which had been momen- 
 tarily interrupted. He evidently had no recollection of 
 the incredibly incongruous act he had just committed.* 
 
 Kussmaul speaks of cases somewhat similar to Dallis- 
 ton's, under the head of Aphthongia, or reflex aphasia, a 
 term used to designate cramps in the territory of distribu- 
 tion of the hypoglossi, which set in whenever an attempt 
 to speak is made, and which render articulate expression 
 impossible. He says they bear resemblance to writer's 
 cramp. 
 
 In one case, a child who was suffering from chronic 
 inflammation of the neck, was suddenly frightened, and 
 was afterwards seized, whenever it attempted to speak, 
 with a spasm of the lingual muscles, which rendered it 
 speechless. 
 
 In another case, the subject was a man in whom an 
 operation for the removal of the tonsils was followed by 
 marked disturbances of sensation, loss of taste, aphonia, 
 cerebral congestion, and epileptiform attacks. On every 
 attempt to speak, the tongue became immovably fixed to 
 the hard palate. The intelligence was unimpaired, and 
 the patient was able to write and to calculate.! 
 
 Professor Ball in a highly interesting article in " L'En- 
 cephale," for March, 1881, relates the clinical history of a 
 
 * Clinique Medicale, torn, ii., p. 23. 
 t " Storungen der Sprache," s. 239. 
 
146 APHASIA, OR LOSS OF SPEECH. 
 
 man, aged 45, who, in a fit of passion, was suddenly struck 
 dumb. Although speechless, he experienced no difficulty 
 in expressing his thoughts in writing. There was no 
 paralysis of motion or of sensibility, the tongue was easily 
 protruded and moved without difficulty from one side to 
 the other, but when the patient attempted to speak, there 
 was a spasmodic contraction of the muscles of the 
 tongue, causing that organ to assume the form of a 
 convex dome, and to be closely applied to the roof of 
 the palate. When he thus made useless attempts to 
 speak, the tongue became hard and stiff, but when at 
 rest it was as soft and flexible as in the normal state. 
 At the end of a few days, and without treatment of any 
 kind, speech was restored as quickly as it was suppressed. 
 M. Ball, whilst refusing to admit the existence of any 
 permanent organic lesion, suggests the hypothesis of a 
 spasmodic ischaemia, limited to an extremely circum- 
 scribed vascular territory, which produces functional 
 disturbance, which disappears with the return of the 
 circulation. He compares the above condition to the 
 temporary loss of visual power described by oculists as 
 " scintillant scotoma," where ophthalmoscopic examina- 
 tion has sometimes demonstrated the existence of anaemia 
 of the retina, evidently of a spasmodic character ; for, 
 although there is sudden and complete blindness, after a 
 few hours' rest, it vanishes as unexpectedly as it arose* 
 
 * Previous to the publication of his essay in L'Encephale, Professor 
 Ball, at the annual meeting of the British Medical Association at Cam- 
 bridge in August, 1880, read a paper on functional ischemia of the brain. 
 In this communication, after citing the clinical history of various cases that 
 had fallen under his own observation, M. Ball maintained that all the 
 symptoms of organic injury of the brain may be caused by functional 
 ischsemia ; also that spasmodic contraction of the brain-vessels, when once 
 
author's own cases. 147 
 
 It will be seen that Dalliston's symptoms differed in 
 many points from those described above. It seemed 
 almost a case sui generis, and on reviewing all the 
 features of it, I am inclined to regard them as due to 
 vaso-motor disturbance — to disorder of the sympathetic 
 system. 
 
 It will be observed that there was invariably an initial 
 aura epileptica, the epileptogenous zone always being in 
 the neighbourhood of the cervical sympathetic. 
 
 The best authority that I am acquainted with on this sub- 
 ject, Professor Eulenberg, adopting Du Bois-Reymond's 
 language, speaks of a hemicrania sympathetico-tonica, 
 which is a disorder of the vaso-motor system, consisting 
 of a tonic spasm of the arteries of the head, caused by 
 tetanus of the cervical region of the sympathetic. 
 
 The transitory and fitful character of the symptoms ; 
 the invariable presence of the epileptic aura ; the epilep- 
 togenous zone being always in the neighbourhood of the 
 cervical sympathetic ; the beneficial result of electricity 
 to this part, all point to the sympathetic system as the 
 seat of the disorder in this exceptionally strange case. 
 
 Whatever may have been the precise pathological 
 condition that gave rise to the anomalous sj^mptoms 
 observed, I cannot think there can have been any 
 persistent change in the organism ; the progress of the 
 case, and the patient's complete recovery would clearly 
 not bear out the hypothesis of any structural injury to 
 the brain. 
 
 induced, may persist for a considerable length of time without producing 
 structural changes in the nervous centres. 
 
 In the discussion which ensued, the president, Sir Crichton Browne, 
 without absolutely dissenting from M. Ball's theory of cerebral ischsemia, 
 said that the symptoms admitted of other explanations, such as small 
 extravasations, embola or patches of neuritis. 
 
I48 APHASIA, OR LOSS OF SPEECH. 
 
 I can imagine that some objection may be made to 
 the employment of the word Logoneurosis. I freely 
 admit the desirability of adopting a nomenclature, 
 which, on the face of it, conveys correct notions of the 
 morbid condition existing, and I am most unwilling to 
 adopt any term which does not imply the anatomico- 
 pathological state of the patient ; but where the patho- 
 genesis is doubtful, it is unwise to employ a term 
 implying accuracy of diagnosis. 
 
 Having for many years kept a record of cases tending 
 to illustrate the pathology of aphasia, that have fallen 
 under my own immediate observation, I could have con- 
 siderably enlarged the above account of my own clinical 
 experience, but as I have already exceeded the limits 
 assigned to this section of my work, I prefer reserving 
 the numerous other cases that have come under my 
 notice for brief allusion in subsequent chapters, where 
 they will serve for illustrating my remarks upon the 
 cause, diagnosis, and treatment of Aphasia. 
 
CHAPTER V. 
 
 Synonyms. Definition of Aphasia. What is Speech? Analysis of the 
 faculty of Language — Max Muller ; Kussmaul ; Whitney ; Ross ; Cerise ; 
 Parchappe. Articulate Language is a Universal attribute of Man — testi- 
 mony of Dr. Moffatt, Sir Bartle Frere, and Sir Samuel Baker. The organs 
 of Voice, and the mechanism of articulation. Articulate language must 
 not be confounded with the General faculty of language. On the language 
 of Nature in contradistinction to acquired or artificial language or Speech — 
 the Natural language of the Voice, of the Physiognomy, and of Gesture. 
 
 In the preceding pages I have endeavoured to review 
 what is at present known of the clinical history of 
 aphasia ; having first ventured critically to analyse a 
 certain number of cases recorded by independent 
 observers in various parts of the world, I have then 
 minutely detailed several cases which I have myself had 
 the opportunity of personally watching. 
 
 It will be observed that the observations which I have 
 recorded in illustration of my subject have been of the 
 most varied character — from the typical case where the 
 loss of speech was complete, to that where the loquelar 
 defect was only a slight or even an occasional symptom, 
 believing that it is only by the careful study of cases 
 illustrative of the various forms and degrees in which 
 derangement of the faculty of speech is observed, that 
 we can hope to throw any light upon this much disputed 
 question — the localisation of the Faculty of Speech. 
 
150 APHASIA, OR LOSS OF SPEECH. 
 
 I shall now proceed to dwell upon certain abstract 
 points suggested by the consideration of the numerous 
 cases to which I have referred in the former parts of this 
 essay. 
 
 In the first place, it may be said that it is unwise to 
 study aphasia as if it were a malady per se ; it is clearly 
 only a symptom, and one common to several morbid 
 conditions, and not a pathological entity having a proper 
 place in any nosological classification. Whilst fully 
 admitting this, however, I maintain that, for the purposes 
 of scientific inquiry, it is convenient at present to study 
 loss of speech — as many other investigators are doing — 
 as if it were really a morbid entity ; for in many of the 
 cases I have reported it was the sole abnormal symptom 
 present. Besides, the faculty of articulate language is the 
 great distinction which the Creator has made between 
 man and the lower animals ; it is one of the highest of 
 human attributes, and there is no subject more worthy 
 of the attention of the philosophical physician than the 
 investigation into the causes which interfere with the 
 proper use of this faculty. I shall, therefore — as it were 
 under protest, and as a matter of convenience — consider 
 aphasia under the various heads of Causes, Varieties, 
 Treatment, &c. 
 
 Synonyms. — Few subjects in medical philology have 
 given rise to so much discussion as the name by which 
 loss of the faculty of articulate language should be 
 scientifically designated, and in no branch of knowledge 
 is it more necessary than in psychology, to define 
 accurately the meaning of the various new terms which 
 are being daily introduced into its nomenclature ; a brief 
 allusion, therefore, to the different names proposed can- 
 not be omitted. 
 
SYNONYMS. I 5 I 
 
 The term Anaudia was used by the Greek physicians 
 for loss of speech, and the adjective uuavSos is employed 
 by ^Eschylus. 
 
 " aldepla kovis /xe "ire'idet (/)ai/euj', 
 avavbos, (ra(f)r]s ; ervfios ayyeXos.' 
 
 " Yon cloud of dust that choaks the air, 
 A true tho' tongueless messenger." 
 
 Alalia is used by Sauvages, Frank, and others, and 
 Professor Lordatf in describing his own case employed 
 the word " Alalie" which latter term has also been 
 adopted by M. Jaccoud. In 1861, M. Broca, when 
 relating to the Anatomical Society of Paris his two 
 remarkable cases, which have since excited so much 
 interest throughout the scientific world, used the word 
 " Aphemie" (afoni); the Hellenists, however, protested, 
 maintaining that it meant infamy, and not loss of speech. 
 This last expression has latterly given way to Aphasia, 
 a word adopted by M. Trousseau, who is supported in 
 his preference for it by no less an authority than M. 
 Littre ; it is a very ancient term for mutism, and occurs 
 twice in Homer ; Iliad xvii., 695 ; and Odyss. iv., 704 ; 
 the text being precisely the same in both instances — 
 "tyv 8i fxiv dficpaalr} areav Xa/3e ; " here speechlessness from 
 emotional causes is evidently implied. 
 
 Finkelnburg, objecting to the term aphasia as only 
 applicable to phonetic symbols, suggests the word, asym- 
 bolia, which would embrace all forms of disturbance in 
 the formation and comprehension of symbols, and more 
 accurately express the morbid derangement of function, 
 
 * Septem Contra Theb. V. 81. 
 
 f " Analyse de la Parole, pour servir a la theorie de divers cas d Alalie et 
 de Paralalie." 1843. 
 
152 APHASIA, OR LOSS OF SPEECH. 
 
 in which the faculty of understanding and communica- 
 ting ideas by acquired signs is either partially or wholly 
 abolished.* 
 
 Kussmaul, who, in the work already quoted, treats not 
 only of the disturbances of speech, but also of the 
 symptomatic phenomena under which the execution or 
 comprehension of any given signs by which it is sought 
 to communicate conceptions is impaired, suggests the 
 word asemia, as he considers the idea contained in 
 " symbol " to be more restricted than that conveyed by 
 the word " sign." 
 
 Other names, such as Aphrasia, Aphthongia, Aph- 
 thenxia, &c.,f have been suggested; indeed, so widespread 
 has been the interest excited in the question of defects 
 of language, that a host of philological suggestions have 
 been made in reference to the generic term most appro- 
 priate for including all degrees of impairment of man's 
 special prerogative, Speech. $ Aphasia, doubtless from 
 
 * Viel einfacher und richtiger erscheint es, von einer "Stoning der sym- 
 bolischen Gehirnfunction " zu reden oder den einheitlichen Ausdruck der 
 " Asymbolie " zu wahlen. "Asymbolie" ware demnach diejenige krank- 
 hafte Functionsstorung, bei welcher das Vermogen, sowohl Begriffe mittels 
 erlernter Zeichen zu verstelien, wie auch Begriffe durch erlernte Zeichen 
 kundzugeben, theilweise oder g'anzlich aufgehoben ist. Es kann also auch 
 ein Taubstummer, jaein Thier, welchem jede Moglicheit einer Wortbildung 
 von jeher gefehlt, doch an Asymbolie erkranken Berliner klinische 
 Wochenschrift. 1870, S. 461. 
 
 •f Dr. Popham, of Cork, considers that of all the words in 'the Greek 
 language denoting modes of speech, the verb QQiyyoixai applies more than 
 any of the others to the formation by the tongue of articulate sounds. The 
 substantive <£0eyf's is used by Hippocrates, and the privative word a<p6ey£i.<; 
 would express an inability to enunciate syllables. Pie also thinks that the 
 English word aphthenxia is as euphonious as many other derivations from 
 the Greek. — Dublin Quarterly Journal, Nov., 1865. 
 
 % These philological contributions have not been restricted to medical 
 
DEFINITION OF APHASIA. 153 
 
 its simplicity and euphony, is now the favourite expres- 
 sion ; it is the one I have selected, and in accordance 
 with the neological phraseology of the clay, I shall 
 adopt the terms— Amnesic, Ataxic, and Epileptiform 
 Aphasia, &c. 
 
 Definition— -The word aphasia has been used in a 
 different sense by different authors; some, like Trousseau, 
 Broca, Auguste Voisin, &c, limit its use to designate that 
 condition in which the intelligence is unaffected, or at all 
 events but slightly impaired ; where thoughts are con- 
 ceived by the patient, but he cannot express himself, 
 either because he has lost the memory of the mechanical 
 process necessary for the pronunciation of these words, 
 or because the rupture of the means of communication 
 between the grey matter of the brain and the organs 
 whose co-operation is necessary to produce speech, does 
 not allow the will to act upon them in a normal manner — 
 the ideas are formed, but the means of communication 
 with the external world does not exist. This definition 
 would exclude all cases in which loss or lesion of speech 
 was. due to the alteration of the peripheral organs which 
 co-operate for the production of sounds, as well as those 
 in which the embarrassment of speech was attributable 
 to a general lesion of the intelligence, such as idiotism, 
 
 writers. Mr. F. W. H. Myers, in an interesting and highly philosophical 
 essay on ''Automatic Writing," criticises at considerable length the 
 numerous terms recently introduced in the description of various disturb- 
 ances of the faculty of speech. He says that a term is wanted which shall 
 include all kinds of defect in the usage of signs— as in piano-playing, 
 drawing, &c, faculties which may or may not be affected along with 
 speech. As he considers " sign-troubles " would have an un-English sound, 
 he suggests asemia, with the adjective asemic— Journal of the Society for 
 Psychical Research, May, 1885, p. 36. 
 
154 APHASIA, OR LOSS OF SPEECH. 
 
 cretinism, deaf-mutism and the different forms of mental 
 alienation. 
 
 I prefer, however, using the word aphasia in its widest 
 and broadest sense, and shall employ this term as a title 
 for the whole group of disorders of speech,* thus embrac- 
 ing not only the loss, but all the various degrees of 
 impairment of that faculty. 
 
 This interpretation of the word necessitates divisions 
 and sub-divisions in which all shades and degrees of the 
 affection may be included, and it has enabled me, in the 
 preceding pages, not only to admit cases where the lesion 
 of speech was decided and more or less permanent, but 
 also those where it appeared only as an epiphenomenon, 
 believing, as I have before stated, that such cases may 
 be more useful than the typical cases which are so 
 frequently put on record. 
 
 Before alluding to any subdivision of the subject, I 
 would, just for one moment, ask what speech is ? 
 
 Speech is a complex faculty dependent upon the 
 integrity of several lunctions, by which man is enabled 
 to give expression to his thoughts by sounds ; it is, 
 therefore, thought expressed phonetically. It is the 
 expression of the thinking spirit in articulate sounds, 
 resulting in the conveyance of ideas from mind to mind 
 in logical method, and is the combination of the in- 
 tellectual and the phonetic elements into one organic 
 
 * M. Jaccoud, in his lectures lately delivered at Lariboisiere, has thus 
 interpreted the word in its broadest sense ; M. Charcot also defines the word 
 as follows: — "The term aphasia, considered in its widest acceptation, com- 
 prises all the various, and sometimes subtile modifications evinced in its 
 pathological condition, by the faculty which man possesses of expressing 
 his thoughts by signs." 
 
WHAT IS SPEECH? I 55 
 
 unity. By it, man is placed on the threshold between 
 the worlds of matter and spirit ; by it, thought becomes 
 materialised, and consequently rendered susceptible of 
 making an impression on one of the senses, the channel 
 for the sensory impressions of spoken words having its 
 commencement in the peripheral expansion of the 
 acoustic nerve, and that of written words in the retina. 
 The mysterious connection between matter and mind as 
 exemplified by the study of language is thus beautifully 
 expressed by Max Muller: "There is, no doubt, in 
 language a transition from the material to the spiritual : 
 the raw material of language belongs to nature, but the 
 form of language, that which really makes language, 
 belongs to the spirit. With one foot language stands, 
 no doubt, in the realm of nature, but with the other in 
 the realm of the spirit ; and I may here express my con- 
 viction that the Science of Language will yet enable us 
 to withstand the extreme theories of the evolutionists, 
 and to draw a hard and fast line between spirit and 
 matter, between man and the brute."* 
 
 This capacity to give outward expression to our in- 
 most thoughts is one of the highest attributes of man- 
 kind, and is a typical sign of humanity ; without it we 
 should be strangers to one another, condemned to know 
 only ourselves ; incapable of combination for any useful 
 purpose, and unable to intercommunicate our wants and 
 desires ; in fact, we should, in a social sense, be but 
 slightly raised above the level of the brute creation. By 
 the possession of language, however, we are able to give 
 to our intellectual conceptions a form which renders 
 them capable of being perceived by the senses of our 
 
 * " Chips from a German Workshop," vol. iv., p. 234. 
 
156 APHASIA, OR LOSS OF SPEECH. 
 
 fellow men ; and by a few articulate sounds, uttered 
 almost with the rapidity of lightning, we are able to 
 summon up a whole train of ideas in the mind of 
 another, and language thus becomes thought outwardly 
 expressed. " La pensee est observable par la conscience 
 et par les sens ; par la conscience, c'est la parole interieure 
 ou le langage interieur; par le sens, c'est le langage 
 proprement dit."* 
 
 Kussmaul describes speech as the grammatical mould- 
 ing of the material of thought, which has been perceived 
 logically, and has been metaphysically elaborated. f 
 
 Whitney describes language as "the instrument of 
 thought, the machinery by which the mind works ; it is 
 the spoken means whereby thought is communicated, 
 and it is only that ; words are not mental acts, they 
 are combinations of sounds, effects produced upon the 
 auditory nerve by atmospheric vibrations, which are 
 brought about by physical agencies — agencies set in 
 operation, it is true, by acts of volition, but whose pro- 
 ducts are no more mental tha 1 are pantomimic motions 
 voluntarily made with the fingers. Language is not 
 thought, nor is thought language, nor is there a mysterious 
 and indissoluble connection between the two, as there is 
 between soul and body, so that the one cannot exist 
 without the other. There can hardly be a greater and 
 more pernicious error, in linguistics or in metaphysics, 
 than the doctrine that language and thought are identical. 
 It is, unfortunately, an error often committed, both by 
 linguists and metaphysicians.''^ 
 
 " Language," says Ross, " is the instrument of the 
 
 * Proust, "De l'Aphasie." Paris, 1872, p. 7. 
 t "Die Storungen der Sprache," S. 29. 
 
 " Language and the Study of Language," pp. 405, 410, 420. 
 
ANALYSIS OF THE FACULTY OF SPEECH. 1 57 
 
 social state, and in order that it may be a means of 
 intercommunication between animals, it must possess to 
 each a subjective and an objective value ; or, in other 
 words, it must fulfil an impressive and an expressive 
 function.* As the outgoing or expressive function 
 always results in a muscular action of some kind, it may 
 be briefly named the motor function of language ; and 
 as the ingoing or impressive function presupposes the 
 activity of the ear, eye, or one of the other senses, it 
 may be named the sensory function of language. 
 Analysis, therefore, leads us to recognise that speech 
 consists of a motor and a sensory function, and that the 
 former of these may be divided into an emissive and an 
 executive department, and the latter into a receptive and 
 an apperceptive department, with their corresponding 
 nervous mechanisms." By the term receptive depart- 
 ment, he indicates " the function of the peripheral sense 
 
 * He illustrates the above remarks by the signal cry of a rook, which, 
 perched on a high tree, utters in quick succession, "Caw, caw, caw," and 
 immediately the neighbouring community of rooks take to flight. The cry 
 indicates that the rook which utters it is in a certain mental condition, but 
 this indication would be of no value to the community unless a similar 
 mental condition were excited in all the rooks that listened to the cry. In 
 order that the active rook may be able to communicate his own emotion or 
 thought to the other rooks, he must be possessed of outgoing or centrifugal 
 mechanisms, by means of which he is able to give a certain signal ; and in 
 order that the signal may fulfil the function of a language, the passive rooks 
 must be possessed of ingoing or centripetal mechanisms, by means of which 
 they are able to appreciate the meaning of the signal, and each rook, in 
 order to be an effective member of the community, must be possessed, of 
 both the outgoing and ingoing mechanisms, so that he may, as occasion 
 requires, be able on the one hand to give warning of the approaching 
 danger to the other rooks, and on the other hand to appreciate the meaning 
 of the warning cry when hearing it from another rook. — " On Aphasia," by 
 J. Ross, M.D., LL.D., p. 2. 
 
158 APHASIA, OR LOSS OF SPEECH. 
 
 organs with their centripetal conducting paths ; by the 
 term apperceptive department, he describes the function 
 of the cortical sensory centres, and he understands the 
 expression apperceptive facility in the wide sense in 
 which Kant employed the term apperception and its 
 cognates. 
 
 At one of the meetings of the memorable discussion 
 at the Academy of Medicine of Paris to which I have 
 already alluded, one of the orators, M. Cerise, described 
 language as a mould of the thought — caique de la pensee. 
 Speech, says he, must be conceived before it is uttered, 
 and in order that it may manifest itself externally, it 
 must be transmitted to certain muscular organs — there 
 must be a muscular act ; thus speech may be considered 
 as an annex of thought.* 
 
 During the same debate, another eminent psychologist, 
 M. Parchappe, analysed at great length the various 
 physiological conditions which are essential for the 
 development of the faculty of language, asserting that 
 the function of speech is accomplished by the manifesta- 
 tion of three distinct modes of physical force — develop- 
 ment of intellectual force in the formation of an idea ; of 
 voluntary force in the determination of acts necessary 
 to translate this idea into words ; of motor force in the 
 voluntary manifestations of the movements resulting in 
 articulate voice. In short, the function of speech com- 
 prises three essential physical elements : Intelligence, 
 Volition, and Movement, f 
 
 Speech, therefore, is a physico-psychical act by which 
 ideas and conceptions are communicated to the outer 
 
 * "Gazette des Hopitaux," June 15, 1865. 
 f "Gazette des Hopitaux," May 11, 1865. 
 
ANALYSIS OF THE FACULTY OF SPEECH. I 59 
 
 world, and by which the mind exercises its power, 
 through the instrumentality of our corporeal organs. It 
 consists of two distinct elements, one physical, somatic, 
 and material — a movement ; the other psychical, the 
 interior speech — the 'Xoyos-, and we must take care not 
 to confound this inward with the outward speech or 
 articulation, which is only a form of expression depen- 
 dent upon the integrity of several different functions, 
 and which is liable to be deranged by a variety of dis- 
 eases of the Nervous System. 
 
 I do not propose to discuss at any length the mechani- 
 cal and acoustical principles of speech, or the complexity 
 of the combined processes concerned in phonation ; still, 
 a few details upon this subject may not be out of place. 
 Max Muller, writing on this subject, says that "although 
 considerable progress has been made in the analysis of 
 the human voice, the difficulties inherent in the subject 
 have been increased rather than diminished by the pro- 
 found and laborious researches carried on independently 
 by physiologists, students of acoustics, and philologists. 
 The human voice opens a field of observation in which 
 three distinct sciences meet. The substance of speech 
 or sound has to be analysed by the mathematician and 
 experimental philosopher ; the organ or instruments of 
 speech have to be examined by the anatomist ; and the 
 history of speech, the actual varieties of sound which 
 have become typified in language, fall to the province of 
 the student of language."* 
 
 It is necessary to bear in mind that vocal sounds and 
 speech or articulate language are two things entirely 
 different, and that the former may be produced in great 
 
 * "Lectures on the Science of Language," 2nd series, p. 101. 
 
 L 
 
l60 ARTICULATE LANGUAGE IS A 
 
 perfection, where there is no capability for the latter. In 
 nearly all air-breathing vertebrate animals there are 
 arrangements for the production of sound or voice, in 
 some parts of the respiratory apparatus. In many 
 animals, the sound admits of being variously modified 
 and altered during and after its production ; and, in 
 man, one such modification occurring in obedience to the 
 dictates of the cerebrum, is speech. 
 
 Animals, especially those of the higher orders, are 
 provided with a complex mechanism for the production 
 and modification of sounds, and are endowed with an 
 exquisitely organised acoustic apparatus for transmitting 
 the impressions of sounds to the brain, but man alone 
 possesses the faculty of grouping and systematically 
 arranging the sounds produced, so as to form a language. 
 
 It has been asserted that Articulate Language is not 
 an attribute universally appertaining to the human race, 
 and that there are tribes of savages who have no speech 
 at all. Books of travel abound with tales of wild men 
 without the use of speech — men who whistle like birds 
 and shriek like apes ; and Lord Monboddo, in his 
 " Origin and Progress of Language," has a long chapter 
 about the homo tetrapus, mutus, hirsutus, which accord- 
 ing to him belongs to a barbarous nation that has not 
 learned the use of speech. 
 
 I cannot dwell upon this point here, but would refer 
 the reader to my treatise on "Darwinism tested by 
 Language,"* where I have discussed the question of the 
 universality of speech at great length, my views being 
 supported by autograph letters to myself from some of 
 the most eminent modern travellers — Dr. Moffatt, Sir 
 Bartle Frere, and Sir Samuel Baker ; the testimony of 
 
 * Rivingtons, London, 1877. 
 
UNIVERSAL ATTRIBUTE OF MAN. l6l 
 
 these distinguished observers militates entirely against 
 the notion of the existence of a speechless tribe, and 
 completely justifies my assertion that Articulate Lan- 
 guage is a Universal Attribute of Man, and that the 
 wildest savage that roams the woods in still undiscovered 
 lands has a language, or the capacity for acquiring it. 
 
 Farrar in his chapter on Sound as the vehicleof Thought, 
 says : — " Man possesses a capacity for the dynamic pro- 
 duction of sound — as a mere animal being in the yet 
 dark and unconscious slumber of infant life. The new- 
 born infant enters the world with a cry, which is a mere 
 natural sound, the expression of animal feeling, and is 
 soon liable to various modifications for the purpose of 
 expressing the different stirrings of life and sensations. 
 These natural sounds are no more speech than the cries 
 of animals are ; no human intelligence is expressed by 
 them ; they are inarticulate and involuntary ; they are 
 mere modifications of the breath, and do not express the 
 thinking spirit. Nevertheless they prove the possession 
 of a high capacity, and this capacity is developed by 
 man into significant speech, as the expression of his 
 highest and innermost nature."* 
 
 "The modification of the voice," says Bishop, " depends 
 on the development of the intellect, and accordingly the 
 lower we descend in the scale of animal life, the less is 
 the power of diversifying vocal sounds." Most of the 
 mammalia are provided with a mechanism capable of 
 producing an extensive range of sounds, but the intellect 
 even of the highest quadrumana is not sufficiently 
 developed to admit of their applying these sounds for 
 
 * "Language and Languages," by F. W. Farrar, D.D., F.R.S., 
 pp. 70—7I- • 
 
1 62 THE ORGANS OF VOICE. 
 
 the purposes of articulate speech." In the various orders 
 of the mammalia, the organs of voice present different 
 grades of development and complexity of structure, 
 producing in each case some peculiarity of timbre or 
 quality of tone, by which we are enabled to distinguish 
 them one from the other. Some species are mute, such 
 as the giraffe, armadillo, and others, whilst some possess 
 voices of greater or less intensity. The sounds produced 
 by the organ of voice constitute the most important 
 means of communication between man and his fellows ; 
 and the power of speech has, therefore, a primary in- 
 fluence on the development of his mental faculties. 
 
 It has been truly remarked by Sir Charles Bell, that 
 for the articulation of a single word the co-operation of 
 a great number of organs is required. For articulate 
 utterance three factors are necessary: first — the emission 
 of breath, due to the regulated action of the lungs, 
 larynx,* and associated respiratory mechanism ; second — 
 the production either of musical notes or of a rustling 
 sound, determined by the passage of the breath through 
 the rima glottidis; a blast of air being thus driven by a 
 more or less expiratory movement, throws into vibrations 
 two elastic membranes — the chorda vocales — which impart 
 their vibrations to the column of air above them, and so 
 give rise to the sound which we call voice, the strength 
 
 * The larynx, with its muscles and cartilages, is in reality a musical 
 instrument of extraordinary perfection, and is generally considered to be a 
 reed instrument, being more closely related to this than to any other variety 
 of musical apparatus. Vocal sounds can be produced, even in the dead 
 subject, by forcing a current of air through the larynx, although the epi- 
 glottis, the upper ligaments of the larynx or false vocal cords, and the 
 upper part of the arytenoid cartilages be removed ; provided the true vocal 
 cords remain entire, with their points of attachment, and be kept tense and 
 so approximated that the fissure of the glottis may be narrow. 
 
THE TONGUE NOT ESSENTIAL TO SPEECH. 163 
 
 of which depends partly on the degree to which the 
 vocal cords can be made to vibrate ; and the different 
 notes which the same voice produces depend upon 
 equivalent variations in the rate of vibration of these 
 cords, which takes place according to the same laws as 
 those of other elastic tongues, and the pitch of the notes 
 is governed by the tension of these laminae ; third — the 
 tones thus produced in the larynx undergo modification 
 by other organs intervening between the glottis and 
 the os externum — the hard and soft palate, uvula, 
 tongue,* teeth, lips, and nostrils, and the result is the 
 production of those articulate sounds which constitute 
 language.f 
 
 Here I must remark that it is important not to con- 
 found the faculty of articulate language with the general 
 
 * The tongue, which is popularly credited with the power of speech, 
 plays only a subordinate, though important part in this function, as shown 
 by cases in which nearly the whole organ has been removed on account of 
 disease, without seriously interfering with speech. A few years ago, Twis- 
 leton published a book, entitled, "The Tongue not essential to Speech," 
 in which he controverted the opinion of Cardinal Newman, that miracles 
 were performed in the post-apostolic period, and that they happen even in 
 the present day. One of the most notorious of these miracles was the 
 recovery of speech by the so-called African Confessor, whose tongue was 
 cut out at Tipasa, A.D. 484, by the order of the heretical vandal Huneric. 
 Twisleton shows that it is not necessary to assume a miracle in order to 
 account for the Confessor's recovery of speech. He further adduces a 
 number of well-authenticated facts from both ancient and modern times, 
 which prove beyond the possibility of a doubt, that even after as much as 
 two-thirds of the tongue has been cut off, the mutilated person can gradually 
 regain the power of intelligible speech by means of properly directed 
 practice (Quoted by Kussmaul op. cit., p. 256). 
 
 f The above brief account of the vocal apparatus is taken principally 
 from the works of Carpenter, Kirkes, and Bristowe, which I have freely 
 consulted in the preparation of this chapter-. 
 
1 64 THE GENERAL FACULTY OF LANGUAGE. 
 
 faculty of language, or the power of associating symbols 
 with conceptions, and of exhibiting these symbols to 
 others ; there are figurative signs, which are symbols 
 addressed to the eye, just as words are symbols addressed 
 to the ear, this is the natural language of the deaf and 
 dumb. This natural language, in contradistinction to 
 artificial language, is inherent to the nature of our 
 organisation, and is the result of that innate capacity 
 which animated beings possess of giving outward expres- 
 sion to their thoughts and desires. Animals know no 
 other, and the higher animals possess it in a high degree 
 of perfection, and in some of them, all their exterior 
 organs, even to the tail, the ears, and the skin, contribute 
 towards giving expression to what is passing within 
 them.* 
 
 Professor Broca's remarks on this subject are so lucid 
 and terse, and of such a philosophical character, that I 
 cannot do better than transcribe them : — " There are 
 several kinds of language; every system of signs which 
 permits the expression of ideas in a manner more or less 
 intelligible, more or less complete, or more or less rapid, 
 is a language in the general sense of the word ; thus 
 speech, mimicry, dactylology, writing both hieroglyphic 
 and phonetic, are so many kinds of language. There is 
 a general faculty of language which presides over all 
 these modes of expression of thought, and which may be 
 defined — the faculty of establishing a constant relation 
 between an idea and a sign, be this sign a sound, a 
 gesture, a figure, or a drawing of any kind. Moreover, 
 each kind of language necessitates the play of certain 
 
 * I shall consider the highly interesting question of the language of 
 animals at greater length in a subsequent chapter. 
 
THE GENERAL FACULTY OF LANGUAGE. 165 
 
 organs of emission and reception. The organs of recep- 
 tion are at one time the ear, at another the eye, and 
 sometimes the touch. As to the organs of emission, they 
 are brought into play by voluntary muscles such as those 
 of the larynx, of the tongue, of the velum palati, of the 
 face, of the upper limbs, &c. Every regular language, 
 then, presupposes the integrity : — First — of a certain 
 number of muscles, of motor nerves which supply them, 
 and of that part of the nervous system from which these 
 nerves arise ; second — of a certain external sensorial 
 apparatus, of the sensitive nerve which supplies it, and of 
 that part of the central nervous system with which this 
 nerve is connected ; third — of that part of the brain 
 which presides over the general faculty of language, such 
 as it has just been defined. The absence or abolition of 
 this faculty renders all kinds of language impossible."* 
 
 It will thus be seen that Articulate Language is by no 
 means the only medium of thought and of expression, 
 for in addition to it, nature has endowed the human race 
 with other interpreters of the condition of the mind, 
 three in number ; they are the voice, the countenance, 
 and gesture. 
 
 These exist from earliest childhood and amongst all 
 people and races, for although the symbols of articulate 
 language differ in various countries — to such an extent 
 that even neighbouring nations do not understand each 
 other — the signs conveyed by the voice, the countenance, 
 and gesture are ostensibly the same everywhere, notwith- 
 standing the variety of races, and the diversity of 
 languages ; they may collectively be termed the natural 
 
 * "Sur le Siege de la Faculte du Langage Articule." 
 
1 66 ON THE NATURAL LANGUAGE OF 
 
 language, in contradistinction to the acquired or artificial 
 language or speech ; whether this natural language is 
 anterior or not to the symbols of speech in the history of 
 humanity, it certainly takes precedence in the history of 
 the individual, for there is no child that has not cried 
 and laughed long before it spoke. 
 
 One of the most striking instances of the extraordinary 
 efficacy of natural language is recorded in the history 
 of Peter the Hermit, who, solely by his voice, his coun- 
 tenance, and his gestures, is said to have swayed and 
 influenced vast multitudes of Crusaders from all parts of 
 the world, who could not understand a word of the 
 language he spoke. The effect thus produced by natural 
 language alone was all the more remarkable as there 
 was nothing in the personal appearance of the hermit to 
 recommend him ; in fact, he is described in Mills' History 
 of the Crusades, as " statura pusillus, et quantum ad 
 exteriorem hominem, personam contemptibilis."* 
 
 It is evident that the great Roman orator was fully 
 alive to the immense advantages to be derived from the 
 systematic cultivation of this natural language when he 
 
 * "Thus spake the Prince : meanwhile his ardent eyes 
 The Hermit Peter lifted to the skies ; 
 His voice, his colour were no more the same ; 
 His rev'rend visage beam'd with holy flame, 
 Pure, warm, sublime ; with zeal prophetic fir'd, 
 And fill'd with rapture, as his God inspir'd, 
 With angels he convers'd, and soaring high 
 Pierc'd the thick veil of dark futurity. 
 Fill'd with unwonted awe and mute surprise, 
 All on his gloomy features fix'd their eyes, 
 All on his alter'd voice attentive hung 
 While hints mysterious thunder'd from his tongue." 
 
 Tasso. Jerusalem Delivered^ Canto x. 645. 
 
THE VOICE, THE COUNTENANCE, AND GESTURE. 1 67 
 
 said : — " Nature has given to every passion its peculiar 
 expression in the voice, the countenance, and the 
 gesture; and the whole body of a man, his look and 
 voice respond to the passions of the mind, as the strings 
 of a musical instrument to the ringers that touch them."* 
 Our own great dramatist was fully sensible of the 
 power of natural language as shown by the following 
 passage : — 
 
 "There's language in her eye, her cheek, her lip, 
 Nay, her foot speaks, her wanton spirits look out 
 At every joint and motive of her body."f 
 
 Long before articulate language is roused into action, 
 the voice has already become the faithful echo of the 
 passions of the mind or of the feelings of the body, 
 which it reveals by its pitch and tone, by its various 
 kinds of cry, sob, and laughter. Our poet laureate 
 has embodied the above idea in the following well- 
 known lines : — 
 
 " An infant crying in the night, 
 An infant crying for the light, 
 And with no language but a cry."J 
 
 Although nature has not denied eloquence to other 
 parts of the body, she has made the countenance of man 
 the most expressive and faithful mirror of his mind. In 
 reference to this subject, Bacon says, " We are not to be 
 influenced by the old adage ' Fronti nulla fides,' for 
 
 * Omnis enim motus animi suum quemdam a natura habet vultum, et 
 sonum et gestum : totumque corpus hominis, et ejus omnis vultus, 
 omnesque voces, ut nervi in fidibus, ita sonant, ut a motu animi quoque sunt 
 pulsar. — Cicero, "De Oratore," lib. iii. 57. 
 
 + Shakespeare, " Troilus and Cressida," act iv. scene 5. 
 
 % Tennyson, "In Memoriam," 54. 
 
1 68 THE LANGUAGE OF PHYSIOGNOMY. 
 
 although this may apply to the generalcomposition of the 
 countenance, there are certain subtile movements of the 
 eyes, mouth, and face by which the door of the mind is 
 unlocked and opened."* The natural language of 
 the physiognomy is a theme in which the fancy of the 
 poets of all countries has revelled. 
 
 " Hfcovcre prjrpbs Kansas vypau X*P a > 
 $a)vrjp fiev ovk d(pr]K.ev, up.p.a.TO)V 8'ajro 
 Upoaeme SdKpvois, uxrre (rrjprjvai (piXa.^f 
 
 " Saepe tacens vocem, verbaque vultus habet." J 
 
 " Your face, my Thane, is as a book, where men 
 May read strange matters."§ 
 
 " Au seul nom de Ce"sar, d'Auguste, et d'empereur, 
 Vous eussiez vu leurs yeux s'enflammer de fureur ; 
 Et dans un meme instant, par un effet contraire, 
 Leur front palir d'horreur, et rougir de colere."|| 
 
 This language of physiognomy all men possess, and 
 all understand it when employed by others. When the 
 mind is tranquil, all parts of the countenance are in a 
 state of repose, but when the mind is agitated, the human 
 face becomes a living picture in which the passions are 
 represented with the utmost faithfulness and precision ; 
 not only does the face act as a whole, but in an isolated 
 manner ; for each region and each muscle speaks its own 
 language, and forms its own peculiar feature in the 
 pictorial representation — each kind of thought, sentiment, 
 
 * "De Augmentis Scientiarum," lib. viii., p. 773. 
 t Euripides, "Phoenissee," 1448. 
 J Ovid, " Ars Amat.," lib. i., 574. 
 § Shakespeare, " Macbeth," act i., scene 5. 
 || Corneille, "Cinna," acte i., scene 3. 
 
THE LANGUAGE OF GESTURE. 1 69 
 
 and feeling, finds in these organs its appropriate ex- 
 pression, and from the conjoint or separate action of these 
 muscles, are represented all the various modifications of 
 joy, sorrow, love, contempt, pride, anger, and fear.* 
 
 A third method of human expression independent of 
 speech is gesture, which is the natural language of the 
 deaf and dumb, and which is adopted amongst all 
 nations, when, from ignorance of the language of a 
 foreign race, they are obliged to communicate without 
 an interpreter. 
 
 A theory has been mooted that gesture was the 
 original language of man, and that articulate speech 
 came afterwards. A discussion upon this point would 
 lead me to the question of the origin of language, about 
 which so much has lately been written ; and as it does 
 not lie in the direct line of my investigations, I refrain 
 from treading upon this dangerous ground, further than 
 to remark that as all points to the belief that primseval 
 language must have been widely different from that of 
 modern civilization, and that its present state of per- 
 fection is the result of a slow and gradual development, 
 
 * Whilst this chapter is passing through the press, my attention has been 
 called to the systematic use of the language of physiognomy in judiciary 
 proceedings in France. 
 
 In describing the office of the juge d? instruction, before whom a 
 suspected person is brought in the first instance, it is stated that "the seat 
 of the magistrate is placed in such a manner that he who occupies it turns 
 his back to the light, in order that he may observe the least change in the 
 countenance of the prisoner, who may betray himself as easily by a gesture, 
 by an attitude, by a look, or by a sudden blush, as by the utterance of 
 articulated words ; and often an unexpected question put to a criminal, who 
 up to that time had been ' impenetrable] has sufficed to enlighten the 
 judge."— Le Soleil, 9 Jnin. 1887. 
 
170 THE LANGUAGE OF GESTURE; 
 
 I have no hesitation in adopting the conclusions of the 
 Archbishop of York, who, in speaking of language says 
 that " the power, and not the results, of its exercise — the 
 germ, and not the tree, was imparted."* 
 
 The system of representing objects and ideas by 
 gesture constitutes a means of expression often success- 
 fully employed by those who are unacquainted with the 
 conventional signs of one another's spoken language ; it 
 is addressed to the eye instead of to the ear as in speech, 
 and consequently becomes an easy mode of communica- 
 tion where the latter medium cannot be adopted. f There 
 cannot be a doubt that gesture may become a most 
 powerful exponent of the condition of the mind, and one 
 writer of the 17th century, Isaac Vossius, has grotesquely 
 exaggerated its value by deliberately preferring it to 
 articulate speech ; and he maintains that more can be 
 expressed by the hand than by the tongue ! This author 
 even expresses regret that the whole human race does 
 not banish "the plague and confusion of so many 
 tongues," and adopt an universal and self-evident system 
 of signs and pantomimic expressions ; he even seems to 
 envy the capabilities of the members of the brute 
 creation, whose condition in this respect, he says, is 
 superior to that of man, inasmuch as the lower animals, 
 
 * " Outline of the Laws of Thought," 47. 
 
 t In his "Researches into the Early History of Mankind," Tylor has 
 an interesting chapter on gesture-language, in which he says that "among 
 the Cistercian monks there exists, or existed, a gesture-language. As a 
 part of this dismal system of mortifying the body, they held speech, except 
 in religious exercises, to be sinful ; but for certain purposes relating to the 
 vile material life that they could not quite shake off, communication among 
 the brethren was necessary, so the difficulty was met by the use of panto- 
 mimic signs. A great part of the Cistercian gesture-signs are either just 
 what the deaf-and-dumb would make, or are so natural that they would at 
 
VOSSIUS, TYLOR, AND KLEINPAUL. 171 
 
 without an interpreter, are better able to give expression 
 to their feelings than any human beings, especially if the 
 latter employ a foreign tongue.* 
 
 A German writer, Kleinpaul, regards it "as a mere 
 accident that phonetic speech (Lautsprache) has come 
 so exclusively into use, since it cannot be doubted that, 
 if gesture-speech (GeberdenspracJie) had been developed 
 
 once understand them. Thus, to make a roof with the fingers means 
 'house ;' to grind the fists together is 'corn;' to 'sing' is indicated by 
 beating time ; 'fire ' is shown by holding up the fore-finger and blowing it 
 out like a candle; 'salt 'is indicated by taking an imaginary pinch and 
 sprinkling it ; ' butter ' by the action of spreading it on the palm of the 
 hand." 
 
 This mode of communication which Tylor assigns to the Cistercians, I 
 am informed applies with as much force to the Carthusians, and, in fact, 
 more or less to all monastic orders and catholic communities, where periods 
 of strict silence are enjoined ; gesture-language being thus put into requisi- 
 tion. In the present day, at Parkminster in Sussex, there is a Carthusian 
 monastery where strict silence is one of the rules of the order, and gesture- 
 language is in full force. 
 
 * As this curious and somewhat rare work is not of easy access to most 
 readers, I give the views of Vossius in his own words : — " Si vel solam 
 spectemus manum, ecquis negare possit, earn motus habere magis con- 
 spicuos et apertos quam ulla habeat lingua, cum nullis coerceatur claustris, 
 et in omnes formas et figuras sit explicabilis? Literas quidem ilia et 
 articulata vocabula depromere nequit, sed profecto si tantundem laboris, ac 
 fit in perdiscendo aliquo sermone, arti impendamus pantomimicae, haud 
 minus forsan clare animi nostri sensus aperire liceret, ac nunc linguae 
 facimus beneficio. Nee quidquam felicitati humani generis decederet, si 
 pulsa tot linguarum peste et confusione unam hanc artem omnes callerent 
 mortales, et signis, nutibus, gestibusque licitum foret quidvis explicare. 
 Nunc vero ita comparatum est ut animalium quae vulgo bruta creduntur, 
 melior longe quam nostra hac in parte videatur conditio, utpote quae 
 promptius, et forsan felicius, sensus et cogitationes suas sine interprete 
 significent, quam ulli queant mortales, praesertim si peregrino utantur 
 sermone." — Is. Vossius, De Poematum Cantu et Viribus Rythmi, pp. 65, 
 66. Oxon, 1763. 
 
172 THE LANGUAGE OF GESTURE ILLUSTRATED 
 
 by a long use of many centuries in the same way as 
 phonetic speech, it would scarcely have been inferior to 
 the latter in completeness, convenience, and variety. - 
 Deaf-mutes, he maintains, are able to produce a scene of 
 Shakespeare in the language of signs."* 
 
 Numerous instances are recorded by various authors 
 of the advantages of gesture, an art in which the pro- 
 fessional mimes of Greece and Rome especially excelled. 
 
 Lucian, in his chapter on Dancing, which is a panegyric 
 on the art of pantomime, after stating that the mimical 
 dancer must possess an accurate acquaintance with 
 various sciences, including geometry, adds that, like 
 Homer's Calchas, he must know all that is, that was, 
 and that shall be hereafter — "T6v 6pxw T ¥ e ^vai xph ™t 
 
 eovra, rdr ecrofiepa, rrpor eoura. 
 
 He mentions several instances of the wonderful talent 
 possessed by a pantomimic dancer in the time of Nero, 
 of which the following is perhaps the most striking : — 
 The famous cynic Demetrius having inveighed in very 
 strong terms against the inutility of the art of dancing, 
 a certain famous mimic, who united to his eminent 
 talent an accurate acquaintance with mythology, asked 
 Demetrius to see him dance, before he passed a verdict 
 upon his art, promising that he would exhibit his 
 pantomime without flutes or singing. Demetrius con- 
 
 * Quoted by Kussmaul, op. cit., Cap. v. II. Kussmaul whilst recog- 
 nising the interesting support which Kleinpaul gives to the theory of the 
 remarkable capability of development inherent in gesture-language, is 
 constrained to add that the latter has failed to convince him of the identity 
 in value between gesture-speech and that of phonation ; and whilst ad- 
 mitting the possible development of dramatic capabilities in the deaf-mutes, 
 he is sceptical as to the power of gesture-language to raise up amongst 
 them a Shakespeare ! 
 
BY LUGIAN, ^ELIANUS, AND MACROBIUS. 1 73 
 
 sented ; the dancer ordered the musicians and singers to 
 be silent, and without any accompaniment of words or 
 music, pourtrayed by his dancing the loves of Venus and 
 Mars, with all their scenes ; how Helios betrayed them 
 to Vulcan ; how the latter watched them and caught 
 them both in his net ; the gods standing by ; Venus 
 blushing and Mars frightened ; in short, all that is con- 
 tained in this history or has reference to it ; and he 
 performed all this with so much dexterity, that Deme- 
 trius, transported with delight, called out to the dancer, 
 ." I not only see, but I hear all your performance, for 
 you seem to speak to me with your hands — ^A K ova 
 
 avdpanre a iroieTs ov% opcS fxovov dXhd fj.01 8o/<e/y rais x e P crl1 ' avraTs 
 
 A similar instance of the extraordinary development 
 of the power of expressing thought by signs and gestures 
 is related by ^lianus : — A tyrant, by name Tryzus, with 
 the view of preventing conspiracies and treasons against 
 himself, commanded that his subjects should not speak 
 together either in public or private. Hereupon they 
 evaded the tyrant's command, and signified their thoughts 
 to each other by the action of the eyes, of the hand, and 
 of the head. The tyrant, conceiving that although they 
 had complied with his order as to silence, their gestures 
 and looks betokened ill towards himself, forthwith pro- 
 hibited this mode of intercourse. Hereupon one of them 
 went into the forum, and without speaking a word wept 
 bitterly ; he was soon surrounded by a number of his 
 fellow-citizens, who also burst into tears. When the 
 news was brought to the tyrant that the inhabitants, 
 although they had ceased to use signs, wept grievously, 
 
 * Lucian, hepi opxhseos, 3 6 , 63. 
 
174 THE GRADUAL TRANSITION FROM 
 
 the edict went forth that they were not to be allowed to 
 give expression to their feelings by weeping. As a result 
 of this last act of despotism, the inhabitants, snatching 
 the weapons from the hands of his guard, killed the 
 tyrant* 
 
 Macrobius informs us that Cicero and Roscius the 
 actor were in the habit of vying with each other, to see 
 which of the two could best express the same ideas, the 
 orator by speech, or the player by mimicry or gesture; 
 and that the result of these experiments was such as to 
 give Roscius so exalted an opinion of his art, that he 
 wrote a book for the express purpose of comparing 
 oratory with acting. f 
 
 The gradual transition from natural to artificial 
 language is well exemplified by watching the proceed- 
 ings of early childhood. The child learns to speak 
 from unconscious impulse, which is directed and con- 
 trolled by the intelligent co-operation of the parent ; the 
 child points to certain objects and persons, this being a 
 sign of recognition of something that had previously 
 made an impression on the optic nerve — in fact, a proof 
 is given of the existence of the faculty of memory ; or, 
 as Kussmaul says, "he is impelled by feelings and 
 pictorial intuitions (bildliche Anscliauungen) which grad- 
 ually become elevated into intelligent conceptions (be- 
 grifflichen Vorstellungen) ; thus we may regard speech 
 in its earliest stages as an acquired reflex. % The parent 
 
 * ^Elianus, Hist. Var. xvi. 22. 
 
 f Macrobius, Sat., lib. ii., c. x., 251 
 
 X "Die Storungen der Sprache," s. 5. Under the head of Movements of 
 Expression (Ausdrucksbewegiingen), Kussmaul includes the various methods 
 by which outward expression is given to the inward mental processes. 
 
NATURAL TO ARTIFICIAL LANGUAGE. 1 75 
 
 now steps in, and the child is taught to connect certain 
 objects and persons with certain conventional signs or 
 symbols called words, and in order to effect this, the 
 auditory apparatus must concur, and speech is the 
 result — the child has learned that a sound uttered by 
 the tongue and recognised by the ear, is thenceforward 
 to represent to his mind a thought, and the faculty of 
 articulate language is for the first time roused into 
 action. 
 
 Those which constitute natural language, such as the play of the features, 
 screaming, weeping, and laughing, he calls congenital reflexes; whereas 
 speech, the acquired reflex, must be learned, and is the outcome of practice. 
 
 In the same chapter, Kussmaul enounces his views of the automatism of 
 the brain, and he suggests that the acquired reflex is nothing but a play of 
 mechanical contrivances learned by rote ; and he institutes a comparison 
 between the mechanism of speech and a telegraphic apparatus. "Panto- 
 mimic acts and spoken and written words," says he, "are nothing but the 
 internal products of self- regulating mechanisms, which are set in ordered 
 motion by feelings and conceptions {Gefiihle und Vorstellungen), just as one 
 can set going a sewing machine without knowing its construction ; and it is 
 evident that in this lies the best guarantee for the even working of these 
 movements, and for the accurate and rapid course of speech. The will 
 finding everything already prepared, has simply to employ the preformed 
 and well-schooled mechanism to carry out its designs, a task thus rendered 
 easy of accomplishment. Just as a general when arranging the hundred 
 thousand members of his well-organised and well-disciplined army, has 
 only to give his orders generally and comprehensively, so we, for the 
 execution of the most complex series of movements of our organs of speech, 
 merely need the expression of a thought by this word or by that sentence, 
 in order actually to utter it. Happily for us, we have not therefore to 
 trouble ourselves about the details necessary for the working of the innumer- 
 able internal telegraphic stations. If our despatch is properly drawn up 
 and handed in, and the organisation is in good order, we may be sure it 
 will reach its address." 
 
 Further on, at page 8, he says that it is certain that speech is learned only 
 by onomatopoesis ; and that the child imitates the words of its mother, in 
 the same way that it imitates the barking of a dog or the bleating of a sheep. 
 
 M 
 
176 .' CONDITIONS NECESSARY FOR THE 
 
 Certain conditions, however, are indispensable for the 
 development of articulate language: — 1st, there must be 
 integrity of thought, or, at all events, an idea must be 
 conceived ; or, as the late Mr. Dunn elegantly remarked, 
 " must be moulded for expression in the seat of in- 
 tellectual actions." 2nd, there must be a connection 
 between the idea conceived, and the conventional signs 
 or symbols which constitute the verbal forms of language. 
 3rd, the idea being conceived and the verbal form found, 
 there must be integrity of the commissural fibres and 
 of the motor centres through which the volitional 
 impulses operate in speech, and the muscles of phonation 
 and of articulation must be able to obey the mandates 
 of the will. 4th, it would seem that all these conditions 
 may exist, and yet there may be aphasia or dysphasia. 
 One of my own cases, that of Anna Maria Moore, is a 
 good illustration of this fact ; she had plenty of ideas, 
 she knew the symbols which corresponded to them — the 
 representative signs of her thoughts ; the muscles of 
 phonation and of articulation were unaffected, the vocal 
 apparatus was intact, but the artist was unable to make 
 use of it ;* she seemed like an accomplished musician, 
 who, although accustomed to perform rapid and difficult 
 passages upon his instrument with the greatest ease and 
 without any conscious effort, suddenly finds himself, 
 under certain unfavourable conditions of excitement or 
 from the abuse of alcoholic stimulants, only able to pro- 
 duce discordant strains — there lacks our fourth condition, 
 
 * Professor Brown-Sequard, in calling attention to the fact that in many 
 cases the patients are unable to articulate, although they can move the 
 tongue and larynx in every direction and can utter sounds very well, re- 
 marks, that in such cases the mental part of the mechanical act is lost, and 
 not the mechanical action itself. 
 
DEVELOPMENT OF ARTICULATE LANGUAGE. 1 77 
 
 the master mind, or what has lately been called the power 
 of co-ordination, which consists in the ability of com- 
 bining- and regulating the delicate movements of the 
 organs of articulation, in such a manner, as to be able 
 without effort to give outward expression to the word- 
 symbols representing the ideas conceived. 
 
 The child is taught to speak as he is taught to walk, 
 and he only speaks because he has been taught ; what 
 he has learned to do he can forget, and aphasia may be 
 the result of the loss of the memory of the movements 
 necessary for the articulation of words; thus it would 
 Seem that one can become aphasic in two ways, either 
 by losing the memory of the symbols of language, or 
 by forgetting the mechanical movements necessary to 
 give expression to such symbols. 
 
 If it should occur to any of my readers that I have in 
 this chapter dwelt at too great length upon the various 
 modes of expression with which nature has endowed 
 mankind, in addition to that of articulate speech, I would 
 remark that the study of the Natural Language of Voice, 
 Physiognomy, and Gesture has not hitherto received 
 that attention which its importance deserves; it has a 
 direct connection with the various forms of disturbances 
 of speech that I am considering in these pages, the 
 pathology of which we shall now be better able to 
 understand. 
 
CHAPTER VI. 
 
 Classification. Discussion at the British Association at Norwich, 186S 
 Varieties. Aphasia may be complete or partial, permanent or inter- 
 mittent. Is sometimes limited to substances ; sometimes to proper names — 
 Thucydides, Baron Larrey's celebrated case of gunshot wound. Defect 
 may be limited to a particular language. Recurring utterances from 
 " fossilisation " of impressions. May be the sole morbid symptom. 
 Heterophasia or Paraphasia. On Agraphia or loss of the faculty of written 
 language. On Mirror-writing, or the reversal of the normal position of the 
 letters. Greek Epigraphy — Welsford, Roberts. Remarkable echo case. — 
 A human parrot. The language of Physiognomy. 
 
 Classification. — The various authors who have written 
 on loss or lesion of speech have each adopted a different 
 classification. I have already alluded to the three 
 divisions of Dr. Jules Falret ; M. Jaccoud makes five ;* 
 Dr. Popham, of Cork, says that two typical forms are to 
 be discriminated — Lethological or Amnesic Aphasia, and 
 Aneural or Ataxic Aphasia; adding that to these two 
 forms there are cognate states, between which and them 
 it is not easy at times to draw the line of demarcation.! 
 
 The idea of this division has been further amplified by 
 Dr. William Ogle, in the admirable essay to which I 
 have before alluded, in which he defines by the term 
 Amnemonic Aphasia that form characterised by loss of 
 the memory of words — by inability to translate ideas 
 into symbols ; but besides this, he says, a second act of 
 
 * "Gazette Hebdomadaire," 1864. 
 f " On Aphasia," p. 5. 
 
CLASSIFICATION: BROCA ; KUSSMAUL. 1 79 
 
 memory is required, closely connected with the former, 
 yet distinct from it. " Not only must we remember 
 words, but we must also remember hozv to say them. 
 The mere memory of words by itself may produce an 
 inward repetition or mental rehearsal of a phrase, but it 
 can do no more; for the utterance of the phrase in 
 articulate sound, this second memory is absolutely re- 
 quisite." To the failure of this second memory Dr. Ogle 
 gives the name of Atactic Aphasia, adding that the loss 
 of speech is due to the want of the co-ordinating power 
 over the muscles of articulation.* 
 
 At the anuual meeting of the British Association, held 
 in Norwich, in August, 1868, Professor Broca, in proposing 
 the adoption of a more precise terminology for express- 
 ing the various forms of defective speech, suggested the 
 following divisions : — Alogia, loss of speech from defective 
 intelligence; Amnesia, from defective memory of words; 
 Aphemia, from a defect in the special faculty of lan- 
 guage ; and Alalia, from defective articulation. f 
 
 Kussmaul combines all disturbances of speech under 
 the name of Lalopathia, but as he says, speech, as an 
 autonomous process, consists of articulation and diction, 
 he recognises two divisions, under the heads respectively 
 
 * St. George's Hospital Reports, Vol. 2, 1867, p. 95. 
 
 f One of the most interesting features of the Norwich meeting — at all 
 events, to the medical profession — was the discussion which followed the 
 reading of papers on Aphasia by Dr. Hughlings Jackson, Mr. Dunn, and 
 M. Broca. The learned Parisian Professor, with great force and eloquence, 
 expounded before a British audience, his own peculiar views as to the seat 
 of speech, illustrating his remarks by a coloured diagram, and a plaster 
 cast. A most animated debate ensued, in which Professor Hughes 
 Bennett, Professor Humphry, Dr. Crisp, Sir Duncan Gibb, Professor Carl 
 Vogt, and others took a part. It may be said of this discussion — Tot 
 homines tot sententice. 
 
180 THE ACTIVE AND PASSIVE PHASE OF LANGUAGE ; 
 
 of Dysarthria and Dysphasia, according as articulation 
 or diction is affected. 
 
 Professor Charcot, in his lectures, recognises two princi- 
 pal divisions, corresponding with what he terms the passive 
 and active phase of the faculty of language ; the passive 
 phase consisting of the auditive and visual memories, or 
 phenomena of reception, by which phonetic and graphic 
 symbols are recognised ; the active phase comprising 
 the reproduction of the said symbols by articulate lan- 
 guage, or by writing — the phenomena of transmission. 
 He thus establishes two classes, according as the obstacle 
 or defect is in the process of reception or of transmission, 
 thus : — 
 
 A. Aphasia of Reception "^ Hearing = Word-Deafness. 
 
 or Sensory, J Sight = Word-Blindness. 
 
 B. Aphasia of Transmission^! Speech = Motor Aphasia (Bouillaud- 
 
 or Motor, J Writing = Agraphia. Broca type). 
 
 From loss of the memory of the me- 
 chanism of speech. 
 
 C. Sensori — motor Aphasia-! 
 
 From loss of the memory of the mechan 
 
 V. ism of writing. 
 
 The pathology of sensory aphasia may receive some 
 elucidation from a brief summary of Dr. Bastian's views 
 of the different types of verbal amnesia, as set forth in 
 an elaborate and highly philosophical essay lately pub- 
 lished, in which he recognises three varieties of verbal 
 memory : — 
 
 1. Auditory Memory. — The memory of the sounds of words, 
 that is, of the auditory impressions representative of different 
 words. 
 
 2. Visual Memory. — The memory of the visual appearances 
 (printed or written) of words, that is, of the visual impressions 
 corresponding with different words. 
 
PHENOMENA OF TRANSMISSION AND OF RECEPTION. l8l 
 
 3. Kinasthctic Memory. — (a) The memory of the different 
 groups of sensory impressions resulting from the mere movements 
 of the vocal organs during the utterance of words (impressions from 
 muscles, mucous membrane, and skin) ; that is, of the kinaesthetic 
 impressions corresponding with the articulation of different words, 
 which I propose to speak of as glosso-kinsesthetic impressions. 
 (6) The memory of the different groups of sensory impressions 
 emanating from muscles, joints, and skin, during the act of writing 
 individual letters and words ; that is, of the kinaesthetic impressions 
 corresponding with the writing of different letters and words, which 
 I propose to speak of as cheiro-kinaesthetic impressions. These 
 several centres are also closely connected with one another by 
 commissural fibres, so that the memory of a word or the recollec- 
 tion of a word in one or other of these modes, doubtless involves 
 some amount of simultaneously revived activity in one or two of 
 the other word-centres. 
 
 C7ieiro-M7i%s. 
 C. 
 
 Es.Word 
 c. 
 
 iX>^ -. 
 
 
 e ,-- 
 
 ^---^ 
 
 Glosso-Kirixs. 
 
 c. 
 
 AwLWorcL 
 c. 
 
 And. W. C, the auditory word centre; Vis. IV. C, the visual word 
 centre ; Glos. Kinces. C, the glosso-kincesthetic word centre ; Chi. Kintzs. C, 
 the cheiro-kinoesthetic word centre ; a, the visuo-auditory commissure ; 
 b, the audito-visual commissure ; c, the audito-kinaesthetic commissure ; 
 d, the visuo-kinsesthetic commissure ; e, e, the visuo-glosso-kinaesthetic 
 commissure; f,f, the cheiro-kinsesthetic-auditory commissure ; /', /', the 
 audito-cheiro-kinsesthetic commissure. The last three commissures represent 
 unusual routes for the transmission of stimuli between the word centres. 
 
 A lesion confined to the auditory word centre would give us that 
 form of auditory amnesia known as " word-deafness " ; a lesion of 
 
1 82 APHASIA, OR LOSS OF SPEECH. 
 
 the visual word centre would give us the form of visual amnesia 
 known as " word-blindness " ; a lesion of the glosso-kinsesthetic 
 word centre would produce that kind of kinesthetic amnesia met 
 with in pure aphasia ; while a lesion of the cheiro-kinaesthetic 
 word centre would give us that other kind of kinesthetic amnesia 
 met with in pure agraphia.* 
 
 Although I have found it useful to adopt the terms 
 Amnesic and Ataxic Aphasia, &c., in the description of 
 my own cases, I do not wish to fetter myself with any 
 system of classification, which must, to a certain extent, 
 be artificial : I propose, however, under the head of 
 " Varieties" to mention the principal forms of the affec- 
 tion which are most commonly met with by the clinical 
 observer. 
 
 Varieties. — There is a great diversity in the particular 
 type or form in which lesion of speech may show itself, 
 for as it is a symptom and not a morbus per se, we cannot 
 expect to find the same uniformity in its manifestation 
 as is to be met with in the description of a specific and 
 well characterised disease ; having no uniform cause, it 
 has no regular stereotyped march, being only a secondary 
 pathological phenomenon, the result of single or multiple 
 organic lesions. It is, therefore, impossible to construct 
 any logical system of classification, still it may help to 
 guide us to a better understanding of our subject, if I 
 adopt an arrangement of some kind, however arbitrary 
 and artificial it may be. 
 
 * British Medical Journal, Oct. 22nd, 1887. "On Different Kinds of 
 Aphasia," by H. Charlton Bastian, F.R.S. By the courtesy of Dr. Bastian 
 I am enabled to reproduce the diagram explanatory of his views. 
 
ITS VARIOUS FORMS. 1 83 
 
 I. — It may differ in degree, from absolute speechless- 
 ness to various grades of imperfection in the use of the 
 faculty of language ; it may be an ephemeral and inter- 
 mittent symptom, lasting a few days, a few hours, or 
 even a shorter period, and leaving no trace, or, it may 
 be a permanent defect.* 
 
 2. — In one variety the defect is limited to substantives 
 generally, of which I have recorded several examples in 
 the preceding pages (Bergmann, Graves, &c). In many 
 of these cases, the defect is supplied by a paraphrase, as 
 was observed in Dr. Bergmann's case, where the patient, 
 being unable to say scissors, said it is what zve cut with. 
 The idea is present, but the word is wanting; a good 
 illustration of this condition was shown by W. Sainty, 
 whose case I have described so minutely (page 100). 
 When I showed him a poker, and asked him what it 
 was, he answered, " I know what it is, and what it is 
 used for, but I cannot say the word." On being asked 
 whether it was a walking stick or a broom, he said, 
 "No"; but immediately the word "poker" was men- 
 tioned, he recognised it as the word-symbol correspond- 
 ing to his idea of the object presented to him. 
 
 In further illustration of this variety I would refer to 
 a case reported by M. Piorry, in which an old priest, 
 
 * Heubner, in describing the disturbance of language which sometimes 
 occurs in cerebral syphilis, says, "The incapacity for speech varies much 
 from time to time, and the patient can often, when unconstrained, succeed 
 in doing what he is no longer able to do in society, or before the examining 
 physician. This all proves that we have to do with a disturbance seated 
 beyond the prime motor centres — a weakness of those organs from which 
 the stimulus proceeds to set these centres in motion — organs, therefore, 
 which we must locate in the grey substance of the cerebrum." — Zkmssens 
 Cyclopaedia, v. 12, p. 821. 
 
1 84 APHASIA, OR LOSS OF SPEECH. 
 
 after an attack of dextral paralysis, had entirely lost the 
 faculty of employing substantives ; the manner in which 
 he expressed himself was most curious — for instance, if 
 he wished to ask for his hat, this unfortunate word hat 
 failed him entirely, and he made use of verbs, pronouns, 
 and adjectives in order to render his idea. " Donnez- 
 moi . . . ce qui se met sur la . . . mais le mot 
 tete ne lui venait pas ; il cherchait vingt fois a exprimer 
 sa pensee, et la chose lui presentait une difficulte insur- 
 montable."* 
 
 It is indeed singular that substantives and proper 
 names, which are first acquired by memory in child- 
 hood, should be sooner forgotten than verbs, adjectives, 
 and other parts of speech which are of a much later 
 acquisition. In noticing this peculiarity, Dr. Osborne 
 offers as an explanation, that nouns are less frequently 
 repeated than verbs or prepositions, which, being in use 
 on every topic which can form the subject of discourse, 
 are retained, when the names of general topics as nouns, 
 or of individual topics as proper names, are forgotten.-f- 
 
 3. — Some persons have only lost the power of saying 
 their own name (Crichton), or the names of other people ; 
 it is not uncommon to find persons whose conversation 
 is perfect with the single exception that they cannot 
 evoke or call up in their mind certain individuals — they 
 
 * Gazette des Hopitaux, May 27, 1865. At the autopsy of this patient, 
 M. Piorry found in the anterior part of the left corpus striatum three 
 apoplectic cysts. 
 
 f " On the Loss of the Faculty of Speech." Dublin Journal of Medical 
 Science, Nov., 1833. This, after Crichton's, is one of the earliest memoirs 
 on our subject which have come under my notice, and contains several 
 highly interesting and well recorded cases. 
 
ITS VARIOUS FORMS. 1 85 
 
 lack the symbol necessary to convey the idea, and their 
 inability in this respect is as complete as if an entire 
 leaf had been torn out from the book of memory; it 
 may, perhaps, be said that this defect is only one of the 
 signs of senile decay — of the failing memory of elderly 
 people; this view, however, does not furnish any ex- 
 planation of the fact of the defect being limited to 
 proper names ; besides, this form occurs in others than 
 in elderly people, and is probably due to the fact that 
 proper names, only denoting individuals and not qualities, 
 do not get incorporated with phrases in which they are 
 constantly occurring spontaneously.* 
 
 Thucydides mentions that many who suffered from 
 the plague which raged at Athens, found, on recovering, 
 that they had not only forgotten the names of their 
 friends and relations, but also their own names.* Pliny, 
 the naturalist, also relates that Messala Corvinus, the 
 orator, could not recall his own name.J 
 
 I have already, at page 53, cited a remarkable instance 
 of this singular defect as recorded by Crichton ; and the 
 following case has come under my own personal obser- 
 vation: — Mr. T. W. B., aged 70, sub-editor of a newspaper, 
 after an attack of paralysis, could not remember my 
 name ; and he told me, moreover, that on one occasion, 
 he left his house with the intention of going to the rail- 
 way station to meet a friend, intending to take a cab at 
 the station ; whilst walking along, it occurred to him 
 
 * " Les termes n'ont pas une liaison necessaire avec les idees ; on veut 
 parler d'un homme qu'on connait beaucoup, dont le caractere, la figure, 
 le maintien, tout est present a l'esprit, hors son nom qu'on veut nommer, 
 et qu'on ne peut rappeler. " — Vauvenargues. Introduction a la connaissance 
 de l'esprit humain. Livre. i., ch. xiii. 
 
 t Thucyd. Hist. Lib. ii. 49. t Plin. Lib. vii. 24. 
 
1 86 BARON LARREY'S CASE OF GUNSHOT WOUND, 
 
 that he was unable to recall his own address, so as to be 
 able to tell the cabman where to conduct him ; he, 
 therefore, returned to his home to ask his daughter 
 where he lived, and he was able to retain this informa- 
 tion just long enough to make it available when he 
 reached the station to meet his friend. 
 
 Under the title of "Wound of the brain, with loss of 
 the memory of substantives," Baron Larrey, 60 years 
 ago, made the following important communication to the 
 Academy of Medicine of Paris. 
 
 A sub-officer of dragoons was shot in the head at the battle of 
 Waterloo. There was copious haemorrhage from the wound, and 
 for a considerable time loss of consciousness. He remained, to- 
 gether with several other wounded Frenchmen, without any 
 assistance, on the field of battle for the space of two days and two 
 nights, and it was only at the end of the second day that he was 
 picked up by a resident of Brussels, and placed under surgical 
 treatment. 
 
 It was then found that a ball had entered the left frontal region, 
 about six or eight millimetres from the eyebrow, at a point corres- 
 ponding to the temporal ridge. The wound was enlarged, and an 
 attempt made to extract the foreign body ; it was found, however, 
 that the ball had entered the cranial cavity to the extent of half its 
 circumference, and the other half was so wedged into the frontal 
 bone, that it was not possible to dislodge it. except by trephining, 
 to which the patient would not consent. There was right hemiplegia, 
 which gradually disappeared under appropriate treatment, and he 
 was soon able to resume active service as a sergeant in an infantry 
 regiment. 
 
 As far as his intellectual faculties were concerned, there was no 
 derangement, except that he was unable to employ substantives or 
 proper names in his conversation. Thus, in his capacity of in- 
 structing sergeant of his company, it was his duty to explain the 
 different movements of the drill, and also to describe the various 
 parts that enter into the composition of a gun ; to accomplish this, 
 he was obliged to refer to his drill-book in order to find the names 
 
WITH LOSS OF THE MEMORY OF SUBSTANTINES. 1 87 
 
 of the objects he was describing. He could also distinguish the 
 soldiers of his company by their height, figure, complexion, or the 
 sound of their voice, but he could not call them by name. 
 
 Nature gradually accommodated itself to the presence in the 
 cranium of this foreign body, and beyond this inability to recall 
 proper names and the names of objects, there remained no other 
 infirmity, and the patient lived for twelve years, and eventually 
 died of phthisis. 
 
 Autopsy. — The ball was found embedded in the substance of the 
 frontal bone, with signs of fracture of the internal table ; the dura 
 mater was strongly adherent to the whole of the left anterior cranial 
 fossa; it was much thicker, more dense than in the normal con- 
 dition. A spheroidal excavation of about seven or eight centimetres 
 in depth, and five centimetres in its horizontal diameter, was dis- 
 covered at the summit, and on the temporal side, of the left anterior 
 lobe of the brain. This excavation was lined with a fine reddish 
 membrane which appeared to be the continuation of the pia mater. 
 The subjacent cerebral substance was healthy, as well as the rest 
 of the brain. The right hemisphere was one-sixth larger than the 
 left ; the four ventricles and the spinal canal were filled with limpid 
 serum.* 
 
 The above observation is all the more interesting, as 
 Napoleon's great surgeon lived long before the attention 
 of the profession was directed to the question of cerebral 
 localisation, and consequently he wrote without any- 
 preconceived notions upon this much controverted 
 subject. 
 
 4. — Perhaps one of the most curious forms in which 
 imperfection of speech shows itself, is where the defect 
 is limited to some particular language, which is com- 
 pletely sponged from the tablet of memory, while other 
 languages remain indelible ; thus, Dr. Beattie (quoted 
 by Dr. Scoresby Jackson) mentions the case of a gentle- 
 
 * Journal de Physiologie de Magendie, torn viii., 1828. 
 
1 88 DEFECT LIMITED TO A PARTICULAR LANGUAGE. 
 
 man, who, after a blow on the head, lost his knowledge 
 of Greek, and did not appear to have lost anything else. 
 Dr. S. Jackson asks — where was that gentleman's Greek 
 deposited, that it could be blotted out by a single stroke, 
 whilst his native language and all else remained ?* 
 
 Dr. Scandella, an Italian, who died at New York in 
 1789, was master of the Italian, French, and English 
 languages; in the beginning of an attack of yellow fever 
 of which he died, he spoke English only ; in the middle 
 of his illness he spoke French only; but on the day of 
 his death, he spoke only in the language of his native 
 country. 
 
 Professor Behier's case, which I have quoted at page 
 30, is a further illustration of this variety, his patient 
 having entirely lost the use of two out of three languages 
 that she had acquired. 
 
 In the year 1886, I had occasion to see in the neigh- 
 bourhood of Paris, in consultation with Dr. de Beauvais, 
 an elderly English gentleman, who was the subject of 
 complex aphasia, one feature of which was an inability to 
 speak French, although that was the language which he 
 habitually used during his 45 years residence in France. 
 
 Dr. Rush, an American physician, in treating of similar 
 disturbances of speech, says: — "There is an oblivion of 
 the names of substances in a vernacular language, and a 
 facility of calling them by their proper names in a dead 
 or foreign language. Dr. Johnson, when dying, forgot 
 the words of the Lord's prayer in English, but attempted 
 to repeat them in Latin. Delirious persons often address 
 their physicians in Latin, or in a foreign tongue."-f* 
 
 * "Edinburgh Medical Journal," February, 1867. 
 
 f "Medical Inquiries and Observations upon Diseases of the Mind." 
 Philadelphia, 1830, p. 274. 
 
LANGUAGES REVIVED DURING DELIRIUM. 189 
 
 As a cognate subject, I wish to call attention to the 
 fact, that not only may a language be lost, but, that in 
 the ravings of delirium it may also be revived, as shown 
 by the following case recorded by Coleridge. 
 
 In a Catholic town in Germany, a young woman of four or five 
 and twenty, who could neither read nor write, was seized with a 
 nervous fever, during which she continued incessantly talking 
 Latin, Greek, and Hebrew, in very pompous tones, and with most 
 distinct enunciation. 
 
 The case had attracted the particular attention of a young 
 physician, and by his statement many eminent physiologists and 
 psychologists visited the town, and cross-examined the case on the 
 spot. Sheets full of her ravings were taken down from her mouth, 
 and were found to consist of sentences, coherent and intelligible 
 each for itself, but with little or no connection with each other. Of 
 the Hebrew, a small portion only could be traced to the Bible, the 
 remainder seemed to be in the rabbinical dialect. 
 
 All trick or conspiracy was out of the question ; not only had the 
 young woman ever been a harmless, simple creature, but she was 
 evidently labouring under a nervous fever. Inquiries having been 
 made as to the antecedents of this girl, it was ascertained that she 
 had formerly lived as servant to an old Protestant pastor, a very 
 learned man, and a great Hebx-ew scholar. It had been the custom 
 of this worthy divine to walk up and down a passage of his house 
 into which the kitchen door opened, and to read to himself, with a 
 loud voice, out of his favourite books, which consisted of rabbinical 
 writings, together with several of the Greek and Latin fathers ; 
 from these works, so many passages were identified with those 
 taken down at the young woman's bedside, that no doubt could 
 remain concerning the true origin of the impressions made on her 
 nervous system."* 
 
 * Coleridge. " Biographia Literaria," Vol. I., p. 1 12. In commenting 
 upon this strange history, Coleridge thus soars into the region of meta- 
 physics : — ; "This authenticated case furnishes both proof and instance, that 
 relics of sensation may exist for an indefinite time in a latent state, in the 
 very same order in which they were originally impressed ; and as we cannot 
 
190 APHASIA, OR LOSS OF SPEECH. 
 
 The above case, and others of a similar character, that 
 have been brought under my notice, would lead to the 
 inference that impressions made upon our consciousness 
 are registered by some change in the condition of the 
 brain, which is consequent upon their reception ; and 
 they also tend to show that the presence of a morbid 
 poison may be the means of resuscitating memories that 
 had long since vanished from the conscious mind. 
 
 5. — In another class we find patients substituting one 
 word for another ; thus Crichton mentions a patient who 
 would ask for his boots when he wanted bread ; the 
 gentleman whose case was observed by Sir Thomas 
 Watson, would say "pamphlet" for camphor; and in 
 one of my own cases — that of C. M. — the patient would 
 say "poker" when he meant the fire. In this erratic 
 speech the defect is sometimes limited to the substitution 
 of one letter for another, as in a case quoted by Crichton, 
 where, after recovery from a fever, one of the first things 
 the patient (a German) desired to have was coffee 
 (kaffee) ; but instead of pronouncing the letter f, he 
 substituted in its place a z, and therefore asked for a cat 
 (kazze), and in every word which had an f, he committed 
 a similar mistake, substituting a z for it.* Dr. Popham, 
 of Cork, cites a similar example. 
 
 rationally suppose the feverish state of the brain to act in any other way 
 than as a stimulus, this fact contributes to make it even probable, that all 
 thoughts are in themselves imperishable ; and that, if the intelligent faculty 
 should be rendered more comprehensive, it would require only a different 
 organisation, the body celestial, instead of the body terrestrial, to bring before 
 every human soul the collective experience of its whole past existence. 
 And this, perchance, is the dread book of judgment, in whose mysterious 
 hieroglyphics every idle word is recorded ! " Page 115. 
 
 * " An Inquiry into Mental Derangement," vol. i., p. 373. 
 
STEREOTYPED PHRASES; RECURRING UTTERANCES. 191 
 
 6. — A certain number of aphasics use stereotyped 
 phrases, always the same, their formula of utterance 
 being a constant repetition of a word or words, which 
 they employ apparently indifferently, in reply to any 
 question put to them ; thus we have seen in one of 
 Trousseau's cases, that the person thus addressed, in- 
 variably replied " riy a pas de danger ;" in Hasbach's 
 case the phrase "gerechter Gott" was the only one at the 
 command of the patient ; the lady whose clinical history 
 I have detailed at page 151, and who was the subject of 
 puerperal aphasia, could only utter three words, " The 
 other day" and these she employed in reply to every 
 question put to her. Others can only pronounce certain 
 monosyllables — in one of Professor Broca's cases the 
 word " Tau," and in one of M. Charcot's the word " Ta," 
 composed the entire vocabulary of the respective patients ; 
 and in one of Dr. S. Jackson's of Pennsylvania, we have 
 seen that the clergyman thus affected, who was totally 
 deprived of articulate speech, could write only the un- 
 intelligible phrase, "Didoes doe the doe." 
 
 In many of these cases, the play of the physiognomy 
 shows that the sense of a question is perfectly under- 
 stood by the patients ; they have not lost the general 
 faculty of language, for they understand written and 
 articulate language when spoken by others ; they pre- 
 serve even the sense and the value of words, both in the 
 auditive and graphic form ; what is wanting in them is 
 not the concurrence of the nerves and muscles engaged 
 in phonation and articulation — for they can pronounce 
 certain syllables spontaneously, and can sometimes re- 
 peat what is said to them — there is, however, wanting a 
 particular faculty which we may call the faculty of 
 articulate language ; or, according to some authors, the 
 
 N 
 
192 APHASIA, OR LOSS OF SPEECH. 
 
 faculty of co-ordinating the movements necessary for 
 the production of articulate language is deficient. 
 
 In most instances the patient can immediately correct 
 himself upon being prompted ; Crichton, however, men- 
 tions the case of a lady who thus substituted one word 
 for another, but who exhibited the singular peculiarity, 
 that when the proper expression of her thought was 
 mentioned to her, she was unable to pronounce it. 
 
 It has been suggested that these' recurring utterances' 
 are the repetitions of the last words that were being 
 spoken, or that were about to be spoken, when a cere- 
 bral break-down set in ; the theory being that "whenever 
 we utter, or whenever we formulate for utterance any 
 proposition, the nerve arrangements so set up remain 
 'organised' for a time as a distinct and independent 
 total ; or, in other words, that the group of nerve modifi- 
 cations which arises on the formation of each of our 
 propositions, persists for at least some short time, as a 
 fixed and strongly marked state. Thus, in the case of 
 an unfortunate catalogue compiler, whose brain broke 
 down into a state of aphasia the moment his work was 
 done, the utterance that was on his tongue repeated 
 itself constantly when he had lost all other speech, and 
 he kept on saying l List complete^ because that group of 
 nerve modification was just formed, and was still per- 
 sistent when the stoppage came ; and, thereby, what 
 would have been only a temporary prominence became 
 fossilised."* 
 
 In further illustration of the above remarks, the follow- 
 ing case may be cited : — A British captain, at the battle 
 
 * Journal of Mental Science, April, 1880, p. 21, being a review of 
 Hughlings Jackson's theories. 
 
ITS VARIOUS FORMS. 1 93 
 
 of the Nile, was in the act of giving an order from the 
 quarter deck of his vessel, when a shot struck him on the 
 head, depriving him immediately of speech. As he 
 survived the injury, he was taken home and remained 
 deprived of sense and speech in Greenwich Hospital for 
 fifteen months. At the end of that period, during which 
 he is said to have manifested no signs of intelligence, an 
 operation was performed on the head, which almost 
 instantaneously restored him to consciousness. He then 
 immediately rose from his bed, and not recognising 
 where he was, or what had occurred, expressed a desire 
 to complete the order which had been so abruptly inter- 
 rupted when he received his injury during the battle 
 fifteen months before.* 
 
 As an instance of this ' fossilisation' of impressions, a 
 modern French philosopher, Paul Janet, mentions the 
 case of an old priest who was incapable of pronouncing 
 distinctly two words having any sense — ' c'etait a peine 
 un begayement ; ' if, however, an appeal was made to his 
 verbal memory, he could recite the fable of La Fontaine, 
 1 Le CocJie et la Mouchel or the celebrated exordium of 
 Father Bridaine, and this he would do with the most 
 perfect distinctness of articulation, although he was 
 evidently incapable of understanding a single word of 
 what he said. In this case, says Paul Janet, the mnemonic 
 mechanism had remained sound at a particular point, 
 which only required stimulation to make it act.f 
 
 * Winslow, op. cit, p. 462. 
 
 \ Le Cervean et la Pensee par Paul Janet, Membre de l'lnstitut, p. 140. 
 This highly philosophical treatise contains much original matter, and is 
 well worthy of a careful perusal by all medical psychologists who are 
 endeavouring to trace the connection between thought and speech. 
 
194 APHASIA, OR LOSS OF SPEECH. 
 
 7. — The loss of speech may be the sole morbid 
 symptom, or it may be accompanied by some paralytic 
 symptom. 
 
 It has been asserted that aphasia without paralysis is 
 uncommon. In a contribution to the Medical Times of 
 January 18th, 1868, Dr. Wilks says: — "When paralysis 
 exists, we believe that some portion of the motor tract 
 must be affected, and that this need not arise from a 
 local lesion of the cortical substance ; consequently it 
 might be thought possible for hemiplegia to occur with- 
 out loss of speech and vice versa, but I cannot find this 
 is the case." 
 
 It is with great diffidence that I venture to criticise 
 the opinion of so eminent an authority as Dr. Wilks ; 
 but the above statement is so utterly at variance with 
 my own experience, that I cannot allow it to pass un- 
 noticed.* 
 
 I could cite numerous cases confirming what I myself 
 have noticed, that the loss of the power of expressing 
 ideas in articulate language is often the only evidence of 
 brain disorder, and amongst the numerous observations 
 recorded in these pages, it will be observed that in a 
 large number the impairment of speech was the only 
 sign of diseased action (vide Andral, Broca, and Dr. S. 
 Jackson, of America). 
 
 One of the most remarkable instances of this variety 
 was that recorded by Trousseau when speaking of the 
 aphasia of his colleague, Professor Rostan. This case is 
 
 * Since the publication of my first edition, I find Dr. Wilks has modified 
 his views, for in his valuable work on "Diseases of the Nervous System," 
 he has an article on " Simple Aphasia," and he even records a typical case, 
 which may be added to the numerous instances I have quoted of uncom- 
 plicated aphasia." 
 
SOMETIMES THE SOLE MORBID SYMPTOM. 1 95 
 
 of such value, from the fact that the subject of it had 
 devoted a long life to the investigation of cerebral 
 disease, and consequently was so well qualified to appre- 
 ciate, and accurately to describe the symptoms he 
 experienced in his own person, that I shall transcribe 
 it here : — 
 
 " Dr. Rostan, being confined to his house from the 
 effects of an accident, had been reading nearly all day, 
 and had thus fatigued his brain. He was engaged in 
 reading one of Lamartine's literary conversations, when, 
 all on a sudden, he perceived that he imperfectly under- 
 stood what he was perusing. He stopped a moment, 
 then resumed his reading, but again experienced the 
 same phenomenon. In his alarm, he wished to call for 
 assistance, when, to his great astonishment, he found 
 himself unable to speak a word. He now fancied him- 
 self the subject of apoplexy, and he immediately caused 
 his arms and legs to execute various complex movements, 
 and found there was no paralysis. Being alone, he 
 rang the bell, and when his servant came, he could 
 not speak a word. He moved his tongue in all direc- 
 tions, and was struck with the strange contrast which 
 existed between the facility of movement of the vocal 
 organs, and the impossibility of giving expression to his 
 thoughts by speech. He now made a sign that he 
 wished to write; but when pen and ink were brought — 
 although he had the perfect use of his hand — he found 
 himself quite as unable to give expression to his thoughts 
 by writing as by speaking. On the arrival of a physician, 
 at the end of two or three hours, Dr. Rostan turned up 
 his sleeve, pointed to the bend of the elbow, and clearly 
 indicated that he wished to be bled. Venesection was 
 hardly finished, when a few words could be uttered ; by 
 
196 APHASIA, OR LOSS OF SPEECH. 
 
 degrees the veil seemed to be removed, and at the end 
 of twelve hours speech was entirely restored, or, to use 
 Professor Trousseau's emphatic language, " tout etait 
 ventre dans I'ordre."* 
 
 A striking example of aphasia without paralysis was 
 published by M. Ange Duval in the "Bulletin de la 
 Sociite de Chirurgie" for 1864 ; the subject of it being a 
 lad five years of age, who fell from a window upon his 
 forehead ; the result of the fall being a fracture of the 
 frontal bone on the left side. The intelligence of this 
 child continued unaffected, and there was no paralysis, 
 but he never uttered another articulate sound. This boy 
 was accidentally drowned thirteen months after his fall, 
 when an examination of the encephalon disclosed a cyst, 
 of the size of a walnut, which was full of serum, and was 
 evidently the result of a former contusion of the left 
 frontal lobe ; this cyst was situated principally in the 
 third left frontal convolution.^ 
 
 In his chapter on partial cerebral anaemia, Hammond, 
 in protesting against the too absolute assertion of Erlen- 
 meyer, that in cerebral embolism, the facial, hypoglossal, 
 and the nerves of the extremities are always more or less 
 affected, mentions the case of a lady, who, after repeated 
 attacks of acute rheumatism with marked aortic insuffi- 
 ciency, was seized with headache and vertigo whilst 
 
 * "Clinique Medicate, torn, ij., p. 573. 
 
 f The details of this case are given at great length by M. de Font-Reaulx 
 in his thesis for the Doctorate at the Faculty of Medicine of Paris, 1866. It 
 seems that the localisation of the faculty of speech has been a subject 
 frequently selected of late for a thesis by graduates of the Paris Faculty. 
 Among the most remarkable, I would mention those of M. de Font-Reaulx 
 and of M. Carrier, both of which have furnished me with interesting 
 matter. 
 
APHASIA WITHOUT PARALYSIS. I97 
 
 conversing with a friend, and her speech was cut short 
 with as much suddenness as though she had been shot. 
 There was no paralysis of the tongue, but all idea of 
 language was abolished ; within forty-eight hours she 
 recovered entirely the faculty of speech.* 
 
 Hughlings Jackson says that sudden and temporary 
 loss of speech occurs with or without one-sided paralytic 
 symptoms in patients who are liable to have convulsive 
 seizures called epileptiform. 
 
 Huguenin, in speaking of traumatic meningitis and 
 contusio cerebri, mentions the case of a fall on the head, 
 in which aphasia, without any other form of paralysis, 
 persisted for fourteen days.f 
 
 Nothnagel, when treating of the occlusion of the 
 cerebral vessels, remarks that cases have occasionally 
 been met with, where no other diagnosis but that of 
 embolism could be entertained, in which the patients 
 were suddenly attacked, entirely without warning, by 
 aphasia, unattended by other symptoms of any kind ; 
 the loss of speech disappearing in the course of one or 
 two days.J 
 
 Not only does pure uncomplicated aphasia occur, 
 but when loss of speech coincides with hemiplegia, the 
 aphasia may persist after the disappearance of the 
 paralysis. An instance of this was mentioned at the 
 Anatomical Society of Paris by M. Pelvet, who, in ex- 
 hibiting the brain of a man, aged 56, stated that he 
 awoke one morning paralysed on the right side of the 
 body, and deprived of the power of speech ; the paralysis 
 lasted only two days, but the aphasia persisted. 
 
 * Diseases of the Nervous System, p. 129. 
 f Ziemssens Cyclopaedia, vol. xii. 673. 
 t Ibid, vol. xii., 197. 
 
198 APHASIA, OR LOSS OF SPEECH. 
 
 My own observation and researches do not lead me 
 to endorse the opinion that aphasia without paralysis is 
 uncommon ; in fact, I have recorded several instances of 
 it in these pages, amongst which I would especially refer 
 to the cases of Dr. Gairdner and of Dr. S. Jackson, at 
 pages 73 and 83, and to these I will add one more that 
 fell under my own personal observation : — 
 
 Thomas Sago, a wherryman, aged 23, was admitted into the 
 Norfolk and Norwich Hospital, under my care, on April 1st, 1878, 
 at 5 p.m. 
 
 An hour previously, whilst engaged in washing his wherry, he 
 was suddenly seized with aphasia and facial convulsions. He 
 walked into the waiting room, but was totally unable to speak a 
 word ; he was quite sensible and intelligent, and able to move his 
 arms and legs well, when asked to do so. His face was pale ; con- 
 stant twitchings of the right side of the face, and snapping of both 
 eyelids; pupils somewhat dilated, conjunctivae insensible; jaws 
 generally close and firmly shut, but the teeth chattered occasionally ; 
 the pulse was slightly quickened, and the breathing somewhat rapid 
 and laboured. 
 
 The facial convulsions lasted for half an hour, when they sub- 
 sided, and the patient had a warm bath ; at 6.45 he had a severe 
 epileptiform seizure lasting only four minutes, and two others 
 within an hour. It was not till 10 p.m., a period of six hours, that 
 he began to speak a few words, the speech continuing gradually to 
 improve. 
 
 Two days after admission, there was again complete aphasia, 
 lasting this time half an hour, preceded by facial twitchings. On 
 several other occasions he lost his speech for three or four minutes, 
 but there never was any motor paralysis of any kind whatever. 
 
 The House-Surgeon, Mr. C. Firth, to whom I am indebted for 
 having carefully noted the details of this case, made an ophthal- 
 moscopic examination, but with almost negative results ; that is, 
 the fundus was redder than usual, veins of the retina large, discs 
 small and pink ; sight good. He had never been taught to write, 
 but could read as well as ever. 
 
APHASIA WITHOUT PARALYSIS. 1 99 
 
 It is impossible to meet with a case more to the 
 point than this, but possibly some may say that there 
 might have been some motor paralysis, very slight, and 
 so evanescent in character as to escape observation. 
 This explanation might apply when the clinical history 
 is mainly obtained from the patient himself or his friends, 
 but here is a case watched in a public hospital with a 
 special view to the elucidation of the point in dispute. 
 There was cerebral irritation, as shown by convulsive 
 action, but never the smallest trace of motor paralysis. 
 
 The occurrence of uncomplicated aphasia seems to me 
 such a well ascertained fact, that I should not have 
 dwelt upon this point at such length, were it not that 
 it has an important bearing upon the question of cerebral 
 localisation ; moreover, the existence of aphasia without 
 paralysis may receive some elucidation from a considera- 
 tion of the chemical, molecular, and thermometrical 
 changes that may arise in the cerebral tissue, a subject 
 that I propose to resume in a subsequent chapter. 
 
 8. — In another variety there is a remarkable perversion 
 of speech ; patients can articulate, but there is no con- 
 nection between the articulated sounds and the ideas 
 which they may wish to convey ; the relation between 
 the ideas and the word-pictures becomes so disordered, 
 that, instead of appropriate terms, words having a totally 
 different meaning, or altogether strange and unintelligible 
 expressions, are enunciated ; moreover, the subjects of 
 this peculiar disturbance of speech do not seem to be 
 aware of the defect, and their faces wear an expression 
 of astonishment at not being understood. To this form, 
 the term Heterophasia or Paraphasia has been applied. 
 
 In illustration of this variety, Dr. Osborne has related 
 
200 HETEROPHASIA, OR PARAPHASIA. 
 
 the history of a gentleman, who, after recovery from an 
 attack of apoplexy, had the mortification of finding him- 
 self deprived of speech ; or rather he spoke, but what he 
 uttered was quite unintelligible, and his extraordinary 
 jargon led to his being treated as a foreigner in the hotel 
 at Dublin, where he stopped. 
 
 In order to ascertain and place on record the peculiar 
 imperfection of language which he exhibited, Dr. Osborne 
 selected the following sentence from the by-laws of the 
 College of Physicians, viz : — " It shall be in the power of 
 the College to examine or not to examine any Licentiate, 
 previous to his admission to a Fellowship, as they shall 
 think Jit." Having requested him to read this aloud, he 
 read as follows : — " An the be what in the temother of the 
 trothotodoo to majorum or that emidrate ein einkrastrai 
 mestreit to ketra totombreidei to ra fromtreido asthat 
 kekritest." 
 
 A few days afterwards the same passage was presented 
 to him, and he then read it as follows : — "Be mather be in 
 the kondreit of the compestret to samtreis amtreit emtreido 
 am t emtreido mestreiterso to Ids eftreido turn bried rede r is o 
 of deid daf drit des trest." 
 
 Dr. Osborne calls attention to the fact, that although 
 the patient appeared generally to know when he spoke 
 wrong, yet he was unable to speak right, notwithstanding, 
 as is proved from the above specimen, he articulated 
 very difficult and unusual syllables, and was completely 
 free from any paralytic affection of the vocal organs.* 
 One very remarkable feature in this case was that his 
 utterances were not in accordance with his mental 
 impressions, for Dr. Osborne clearly ascertained that 
 
 * Osborne, op. citato, p. 1 60. 
 
OSBORNE; BROWNE; TROUSSEAU. 201 
 
 although he employed strange words having no connection 
 whatever with the printed text before him, he really- 
 understood the sense of what he was purporting to read. 
 In fact, he continued to read a newspaper every day, 
 and when questioned, it was proved that he had a very 
 clear recollection of all that he read. 
 
 Dr. W. A. Browne has recorded a characteristic ex- 
 emplification of the above in the following passage, taken 
 down from the lips of a female patient in the West 
 Riding Asylum : — " Kallulios, tallulios, Kaskos, tellulios, 
 Karoka, Keka, tarrorei, Kareka, sallulios." This patient 
 would jargonise in this way uninterruptedly for hours 
 together, all the sounds being similar in character to 
 those of the above specimen, and having a vague resem- 
 blance to Greek. When spoken to or asked a question, 
 she always replied in the above manner, and seemed 
 surprised that the person whom she addressed did not 
 understand her.* 
 
 Trousseau has recorded the case of a lady, who, with- 
 out having ever experienced any paralytic symptom, 
 was affected with the following strange perversion of 
 speech. f On receiving a call from a visitor, she rose to 
 receive him with a benevolent smile on her countenance, 
 and pointing to a chair, said — "Pig, Brute, Stupid Fool." 
 
 "Mrs. B begs you to be seated," said a relative 
 
 who was present, and who thus became the interpreter 
 
 * West Riding Medical Reports, Vol. ii. It will be observed that in the 
 above case, as well as in that recorded by Dr. Osborne, the syllabic con- 
 struction of the words used was perfect, and the flow of speech smooth 
 and continuous ; the sentences themselves, however, being a combination of 
 meaningless words, quite unintelligible to the hearers, and in no way, 
 probably, representing the thoughts of the speaker. 
 
 t Clinique Medicale, torn, ij., p. 576. 
 
202 THE " SPECTATOR ON HETEROPHASIA. 
 
 of the wishes of the patient thus strangely expressed. 
 Trousseau adds that the acts of this lady seemed logical 
 and sensible, and, strange to say, she did not seem to be 
 aware of the foul language she was using.* 
 
 Dr. W. T. Moore, of Dublin, has also published a 
 similar case of a gentleman, aged fifty-six, who, after an 
 attack of hemiplegia, completely lost the connection 
 between ideas and words. On one occasion Dr. Moore 
 was much puzzled by the patient saying to him — " Clean 
 my boots!' Finding that he was not understood, he 
 
 * In a lengthened notice of my first edition in the Spectator, the writer 
 of the article, after dwelling especially upon the cases reported under the 
 head of Heterophasia, asks "How is it to be explained that without any 
 loss of intelligence, the great 'instrument of thought,' as language has been 
 called, should so completely defy the power which produced it and defined 
 its exact sphere of duty ? " 
 
 Then he proceeds to institute a comparison between these strange per- 
 versions of speech and the kinesic disturbances observed in chorea. "As 
 regards the mere incapacity for rightly directing the muscles so as to 
 articulate the proper sounds, while the clear power to recognise the right 
 sounds as articulated by others, remains — the commonest form of aphasia — 
 we do not know that there is anything more remarkable than in that in- 
 capacity to restrain the muscles of the arm to their proper functions which 
 is so frequently exhibited by sufferers from St. Vitus's dance. A man, who, 
 on meeting you in the street, suddenly points up to the clock of St. Paul's 
 instead of shaking hands, is really in precisely the same position as the lady 
 who said, "Pig, brute, stupid fool," instead of "I am glad to see you," — 
 supposing, that is, that the latter clearly recognised her own mis-direction of 
 oral energy. The failure was solely in the proper nervous control over 
 certain muscles, and though the effect is much stranger and more grotesque 
 to us in relation to language than in relation to muscular movements of the 
 arm, there is no real difference. A man partially paralysed attempting to 
 move, will often do the very opposite thing to what he attempted, but that 
 does not in any degree affect the condition of his mind, only the control of 
 the mind over his body. And so also it is, when the wrong words come 
 out of the mouth, and are recognised by the speaker to be the wrong words." 
 The Spectator, June 3, 1871, p. 667. 
 
MOORE ; GAIRDNER J KUSSMAUL. 203 
 
 became much excited, and cried out vehemently — 
 "Clean my boots by zvalking on them!" At length it 
 was ascertained that the cause of his disquietude was the 
 shining of the candle on his face, and that the object of 
 his unintelligible sentences was to have the curtain 
 drawn ; when this was done he appeared quite gratified. 
 This patient slowly improved from this attack, but 
 became a lunatic, in which state he survived for fifteen 
 or sixteen years. In commenting on this singular case, 
 Dr. Moore calls attention to the fact that, although there 
 was no connection whatever between the words used 
 and the ideas intended to be conveyed, this patient 
 formed complete sentences : the power of co-ordination 
 and of articulation was perfect, and the intelligence was, 
 to all appearance, unimpaired. 
 
 In a discussion on Emotional Aphasia, at Edinburgh, 
 Dr. Gairdner, said he remembered a case personal to 
 himself. When going through the wards of the Glasgow 
 Infirmary, after a deal of hard professional work, he lost 
 command of his tongue, and found himself talking non- 
 sense — absolute nonsense ; he knew it was nonsense, 
 yet he could not help it, and he felt for the time being, 
 that he must speak nonsense. At the same time he was 
 attacked with dizziness, but after resting a little, he 
 regained the control of himself, and the symptom never 
 occurred again. This attack Dr. Gairdner could only 
 attribute to the extreme fatigue he at that time ex- 
 perienced. Dr. Gairdner mentioned also the case of a 
 Scotch sheriff, who, at one period of his life, felt 
 occasionally that he must speak nonsense — absolute 
 nonsense; later in life this tendency left him entirely. 
 
 In speaking of the above form of speech disturbance, 
 Kussmaul says that "there is an inability properly to 
 
204 APHASIA, OR LOSS OF SPEECH. 
 
 connect the word-images (die Wortbilder) with their 
 corresponding 1 conceptions (Vorstellungen), so that in- 
 stead of those corresponding to the sense, misplaced or 
 entirely incomprehensible word-images present them- 
 selves." He also adds that "there is a form of para- 
 phasia which does not overstep physiological limits, and 
 that persons in good health frequently make mistakes in 
 speaking, of which they may or may not be conscious. 
 These mistakes are due to absence of mind. The same 
 cause — want of attention — which may develop into a 
 state of intellectual confusion, is also usually the starting- 
 point of pathological paraphasia. At all events, it is 
 certain that by means of attention, we exercise an in- 
 fluence over the motor and sensory central apparatus of 
 language, which is indispensable for correctness of speech. 
 When the attention flags, inappropriate words are often 
 used ; and the defects in accentuation, in intonation, and 
 in literal and syllabic enunciation, may be such as to 
 render the speaker quite unintelligible."* 
 
 Dr. Wibe, of Lede, has recorded a case in which the 
 speech disorder assumed the form of verbal delirium, as 
 a result of a traumatic lesion : — A man, aged 26, received 
 a blow in the left temporal region, just above the ear, 
 causing a fracture with depression. The bone was 
 elevated, and the febrile symptoms previously existing 
 subsided, but disturbance of speech was observed, the 
 peculiarity of which consisted in his inability to control 
 his language ; and whilst at church in the middle of his 
 prayers, he began to swear in spite of himself, being 
 quite unable to restrain his oaths.f 
 
 * Die Storungen der Sprache, s. 155, 187. 
 
 t Bulletin de la Societe de Medecine Mentale de Belgique, 1884, No. 33, 
 p. 24. 
 
IS THOUGHT POSSIBLE WITHOUT WORD-IMAGES ? 205 
 
 It has long been a vexed question whether it be 
 possible to reason mentally without having the words in 
 the mind which represent the subject of our reasoning ; 
 whether, according to Condillac, intelligent thought is 
 bound up with words, or whether it is quite independent 
 of them, as maintained by Locke, Maudsley, and others. 
 A careful consideration of the above cases of perversion 
 of speech would seem to justify the conclusion that con- 
 ceptions may originate without words, and that thought, 
 and clear thought is possible without its corresponding 
 word-images. 
 
 9. — The defect may be limited to the loss of articulate 
 language only, or may extend to written language, and 
 also to the language of signs. One of these faculties 
 may be destroyed whilst the others remain intact. 
 
 Writing, next to speech, is the most important channel 
 for the manifestation of the operations of the mind, and 
 yet it is only quite recently that the diagnostic value of 
 its morbid alterations has been recognised. M. Charcot 
 defines Agraphia as Aphasia of the hand. Agraphia is 
 for writing, what aphasia is for articulate language — that 
 is, it is not a material but a psycliical inability to write ; 
 they are both functional troubles of the same nature, but 
 the result of different morbid conditions ; most authorities 
 placing the lesion in motor aphasia in the posterior part 
 of the third left frontal convolution, whilst motor agraphia 
 is attributed to lesion of the posterior part of the second 
 left frontal convolution — the supposed centre for writing. 
 
 In an interesting essay, entitled " Die Schrift," Dr. 
 Erlenmeyer has pointed out that the mind, as well as 
 the hand, contributes to the production of written lan- 
 guage; the disturbances of this faculty are, therefore, 
 
2o6 AGRAPHIA, OR LOSS OF THE POWER OF 
 
 psychical as well as mechanical. The mechanical 
 troubles affect only the composition of the writing itself — 
 that is its form ; the psychical troubles, on the contrary, 
 affect the nature of the contents of the writing — that is, 
 the grammar and the style.* 
 
 It would seem that loss of speech more commonly 
 coincides with loss of the power of writing ; this, however, 
 is by no means invariably the case, and Dr. Wm. Ogle 
 has recorded a case of dextral paralysis in which the 
 speech was limited to the two words "yes" and "no," 
 but the power of writing, with the left hand, remained in 
 its integrity. Trousseau records a similar case of a man, 
 who, in coming to consult him, informed him by signs 
 of his inability to speak, but gave him a note, written in 
 a firm hand by himself, in which was contained a detailed 
 account of his disorder ; from this note M. Trousseau 
 learned that some days previously he had suddenly lost 
 consciousness, on recovery from which there was no 
 symptom of paralysis, but he found himself unable to 
 articulate a single word.f 
 
 Dr. Ogle considers that the occasional separation of 
 agraphia and aphasia is an argument in favour of the 
 existence of distinct cerebral centres for the faculties 
 concerned in speaking and writing ; while the more 
 frequent coincidence of the two would lead him to infer 
 that these distinct centres must be closely contiguous.* 
 
 * Bulletin de la Societe de Medecine Mentale de Belgique. 
 
 + " Clinique Medicale," torn, j., p. 615. 
 
 J St. George's Hosp. Rep., Vol. 2, 1867, p. 100. The word agraphia 
 was introduced by Dr. Wm. Ogle ; it is, however, a new revival of an 
 old Greek word mentioned in Stephen's Thesaurus. Bernard says this is 
 the third example of a very extraordinary resurrection of words, such as 
 Horace scarcely foresaw (Multa renascentur, quae jam cecidere). A Greek, 
 
EXPRESSING THOUGHT BY WRITTEN LANGUAGE. 20J 
 
 Winslow and Marce have mentioned instances where 
 the faculty of writing was lost, whilst that of articulate 
 speech was preserved, showing that, whilst the memory 
 of words is retained, the patient, although not affected 
 with any paralysis of the hand, may still be unable to 
 write. The power both of speaking and writing spon- 
 taneously may be suspended, and yet the faculty of 
 imitation may be so well developed that words can be 
 repeated, and even written without difficulty, when they 
 are pronounced by another person.* Patients who have 
 entirely lost the power of giving expression to their 
 thoughts in writing, may still be able to write from 
 dictation, or can copy from a printed or written page ; 
 others can trace correctly geometrical figures. 
 
 The following case has recently been published by 
 M. Pitres, and presents so many features of interest in 
 reference to agraphia, that I add a condensed account 
 of it. As the patient had neither word-blindness nor 
 word-deafness, it furnishes a typical example of the 
 uncomplicated form of the disorder I am now con- 
 sidering. 
 
 M. Leopold L , a wine merchant, at the age of 21, contracted 
 
 syphilis, and subsequently led a most irregular life. At the age of 
 31, he was suddenly seized with right hemiplegia and aphasia. 
 
 Chrysaphis ; a Frenchman, Broca ; and an Englishman, Ogle, employed 
 essentially Greek words, under the impression that they were inventing new 
 terms. 
 
 * Sir Thomas Watson has kindly communicated to me the particulars of 
 a case of dextral paralysis, with not only loss of the power of speaking and 
 writing, but the patient had forgotten her letters, and could not pick out an 
 s or an n in a child's alphabet. This I believe to be an unusual condition, 
 for in most cases the symbol representing a word is recognised when put 
 before the patient ; that is when, as in Sir T. Watson's case, the intelligence 
 is unaffected. 
 
 O 
 
208 AGRAPHIA. 
 
 Under a vigorous anti-syphilitic treatment, he recovered his speech 
 in eight days ; the motor power, however, was regained more 
 slowly, but at the end of eighteen months, the paralysis had entirely 
 disappeared, with the exception of slightly diminished motor power 
 in the right hand, the dynamometric pressure of which was 34 
 kilogrammes as compared with 34 kilogrammes for the left ; the 
 hand-grasp thus being equal on both sides. The right leg, however, 
 was the seat of slight permanent rigidity. The following very 
 interesting functional troubles were then observed : — The in- 
 tellect was unaffected, and articulate speech was perfect, there 
 being no impediment in the articulation of words. The patient 
 could read aloud, and with the same facility both written and 
 printed matter, and perfectly understood the purport of what he 
 was reading. When interrogated in reference to his symptoms, he 
 replied that he experienced nothing abnormal but a little stiffness 
 in the right lower limb, and an absolute impossibility to write with 
 the right hand, although he could move the hand easily in all 
 directions, and was able to use it for dressing himself, for eating, 
 and for every other purpose except writing, which he had learnt to 
 do very creditably with the left hand. His hearing, taste, and 
 smelling were normal ; but optometric examination disclosed a very 
 decided right-sided hemianopsia. 
 
 In order to test his powers of writing, he was placed before a 
 table, and being furnished with paper and a pencil, was requested 
 to write with the right hand the word "Bordeaux." He took the 
 pencil in his hand, holding it in the proper position apparently 
 without any difficulty, but he was totally unable to write a single 
 letter. He perfectly understood mentally the letters which he must 
 trace in order to write the word, and he spelt the letters which 
 entered into its composition B, o, r, &c. ; he pointed out these letters 
 in a newspaper, but he was unable to write them. " I know very 
 well," he said, "how the word Bordeaux is written, but when I 
 wish to write with my right hand, I can do nothing." With the 
 left hand, he wrote very legibly and correctly, " Bordeaux ; " then 
 taking the pencil in his right hand, and looking repeatedly at each 
 letter which he had just written, he succeeded in reproducing it 
 with the right hand ; he could copy that which he could not write. 
 
 He was then asked if he recognised the shape of single letters, 
 
AGRAPHIA. 209 
 
 the letter L, for instance ; he replied in the affirmative, and in order 
 to prove it, he looked for this letter, and pointed it out as occurring 
 in several printed or written words. On being requested to write 
 this letter with the right hand, he was only able to make incoherent 
 scrawls, in nowise resembling the general shape of the letter L. 
 He could, however, write this letter very well with the left hand, 
 and when he had it under his eyes, he could recopy it roughly with 
 the right hand. The result was the same with other letters, 
 p, c, x, &c. 
 
 The same series of phenomena was observed for figures. He 
 could read out figures without any hesitation, and could even make 
 a mental calculation, and if several numbers were placed one below 
 another, he could add them up without a mistake, but he was 
 unable to write down the total with his right hand. On being 
 asked to write down the number 125, he could only succeed in 
 doing it, after having previously written it with his left hand, al- 
 though he knew the number was composed of the figures 1, 2, 
 and 5. 
 
 If instead of asking him to write a word, a letter, or a figure, he 
 was requested to draw a geometrical figure — a circle, a triangle, or 
 an octagon, he did it instantly with the right hand ; he was also 
 able to sketch with the right hand the profile of a human form, in 
 proper proportions.* 
 
 On summarising the above clinical history, it will be 
 seen to be a case of aphasia, as the result of syphilitic 
 disease of the brain, with rapid recovery of the power 
 of articulate speech, but with persistent agraphia, charac- 
 terised by the capacity of copying written and printed 
 matter ; moreover, the patient copied not only the 
 models that were placed before him, but he could copy 
 with his right hand what he himself had written with his 
 left, although he was totally unable spontaneously to trace 
 a single letter with the right hand. It will be observed, 
 however, that the inability to write with the right hand 
 
 * A. Fitres. — Considerations sur l'agraphie (Revue de Medecine, 1884, 
 tome iv., p. 855). 
 
2IO ON MIRROR-WRITING, OR THE REVERSAL 
 
 did not depend upon any common paralysis of the 
 muscles of the hand or of the fore-arm, for the patient 
 was able to trace on paper geometrical figures, and even 
 to draw the outline of the human form ; what was 
 wanting was the memory of the different movements 
 necessary for tracing written characters ; the fault, there- 
 fore, was not in the right hand itself, but in the orders 
 sent down to it from the brain, or as Dr. Bastian would 
 say, the defect was in the cheiro-kinaesthetic centre. 
 
 There is a form of writing which has been described 
 by Buchwald under the name of Spiegel- Schrift, or 
 Mirror-writing, in which those affected with this peculi- 
 arity write from right to left — the normal position of the 
 letters being reversed.* 
 
 Bernard mentions a curious case of a laundress who 
 was the subject of progressive locomotor ataxia, and 
 who from partial paralysis was unable to write with the 
 right hand, but wrote in mirror-writing with the left. 
 She was able to read what she had written, but was not 
 aware that it differed from ordinary writing ; she could 
 not understand why she received no replies to her letters, 
 which of course no one could read, and she attributed 
 the silence of her correspondents to other motives. The 
 same writer reminds us that the first seven letters of the 
 Greek chieftain Agamemnon are in Mirror-writing, in 
 the Hall of Phidias at the Louvre, the last two letters 
 
 * Berliner klinische Wochenschrift, 1878. In this communication, the 
 author reports three cases illustrative of reversed writing in brain disease, 
 and in all of them, there was right hemiplegia and aphasia. On looking 
 over the records of his Klinik, Buchwald found that no tendency to mirror- 
 writing had existed in cases where the paralysis and aphasia had been of 
 slight degree, nor when they had been of short duration. 
 
OF THE NORMAL POSITION OF THE LETTERS. 211 
 
 however, being turned round from left to right ;* the word 
 would, therefore, seem to be written after an ancient 
 mode, which is observed in the Sigeian Inscriptions 
 on the Arundel marbles. This mode of writing was 
 characterised by the term Bova-Tpo^duu.f 
 
 io. — In reference to the language of signs and of pan- 
 tomimic expression, it is more commonly unaffected, and 
 some authors have even defined aphasia as the loss of 
 artificial language, with the preservation of natural 
 
 * Bernard, " De l'aphasie et de ses diverses formes," pp. 235, 237. 
 
 f In a chapter on the Diversities of Language, Mr. Welsford gives the 
 following interesting details in reference to this mode of writing : — The 
 great family of the Shemitic or Arabic class of languages, the Hebrew, the 
 Chaldee, the Syriac, the Samaritan, and of course the Arabic itself, have 
 from time to time immemorial been written from right to left ; while, on 
 the other hand, the Sanskrit or Indian class of languages, comprehending 
 the Sarmatian or great Slavonic family, together with all the languages of 
 modern Europe, are now written from left to right. But this was not al- 
 ways the case, for a few of the oldest Greek inscriptions, denominated 
 Bova-Tpo(j>r]&bv, from their supposed resemblance to the action of an ox 
 ploughing, are written in lines running from left to right, and from right to 
 left alternately. This mode of writing may be regarded as a connecting 
 link between the two great families of languages, of which the Arabic and 
 the Sanskrit may be regarded as the keys ; but there are grounds for suspect- 
 ing that, at a still earlier period, the Greeks wrote entirely from right to 
 left like the Phoenicians, as by far the larger part of the inscriptions 
 denominated Etruscan, but which are really little more than the remains of 
 the Greeks settled in Italy, are written in the same manner. — Mithridates 
 Minor, or an Essay on Language, p. 27. 
 
 In a personal communication with which I have been favoured from the 
 Rev. E. S. Roberts, of Caius College, Cambridge, the accomplished author of 
 "Greek Epigraphy," Mr. Roberts remarks that instances of Bovo-Tpo^Sbi' 
 writing in Greek inscriptions may now be described as very numerous rather 
 than few. Moreover, the numerous ancient Greek inscriptions from Crete 
 show conclusively that the Greeks, for some time after the derivation of 
 their alphabet from the Phoenicians, wrote only from right to left. 
 
212 APHASIA, OR LOSS OF SPEECH. 
 
 language. Ballet disputes this statement, remarking 
 that in certain cases natural language is disturbed to 
 the same extent as the artificial. Mimicry, says he, 
 forms although perhaps a very elementary, still a real 
 form of language, which, like other forms, has its patho- 
 logical disturbances — amimia.* 
 
 In most of the recorded cases the power of communi- 
 cation by signs is not mentioned at all. Lelong, the 
 subject of one of Broca's celebrated cases, could make 
 himself entirely understood by his expressive mimic; 
 I have recorded the same fact in the history of my 
 patient Sainty. The eminent surgeon, Sir William 
 Lawrence, was the subject of hemiplegia with aphasia, 
 and Sir Thomas Watson, who attended him, thought it 
 desirable to give the patient some sedative. Lawrence 
 knowing this, and wishing to indicate what remedy he 
 desired, was unable to find the word he wanted, and 
 became greatly agitated in consequence. Sir Thomas 
 Watson got pen, paper, and ink, and asked him to write 
 the word. This he could not do, but taking the pen full 
 of ink, made a large splash on the paper, and offered it 
 to those at his side. Sir Thomas Watson at once 
 perceived the drift of this, and saw that his patient wished 
 for the "black drop," a discovery which greatly delighted 
 and satisfied Lawrence. 
 
 Sometimes, pantomimic language, without being 
 abolished, is wanting in precision or is perverted, as was 
 observed by Dr. Perroud, of Lyons, whose patient would 
 make a sign of affirmation when she meant the contrary.f 
 I have lately seen a similar case with my friend 
 
 * G. Ballet. " Le Langage Interieur," pp. 3, 73. Paris, 1886. 
 t De Font-Reaulx, op. cit., p. 57. 
 
THE ECHO SIGN; A HUMAN PARROT. 213 
 
 Mr. Morgan, in which the signs for assent and dissent 
 were reversed. To this particular form of disturbance of 
 expression by gesture, Kussmaul has given the name of 
 Paramimia. 
 
 Sometimes the faculty of imitation is exaggerated to 
 an extraordinary degree, when the phenomenon is pro- 
 duced which Romberg calls the " echo sign." During a 
 recent visit to La Salpetriere, Dr. Auguste Voisin kindly 
 called my attention to a remarkable instance of this form 
 then in one of the wards. The subject of it was a 
 woman, aged 56, who had right hemiplegia with aphasia, 
 and who, although she never spoke, repeated all that 
 was said — for instance, Dr. Voisin addresssd her thus, 
 "Voulez vous manger?" She said, instantly, "Voulez 
 vous manger?" I then said to her, "Quel age avez 
 vous?" She replied, " Quel age avez vous?" I then 
 said to her in English, "You are a bad woman." She 
 instantly said, "You are a bad woman." I said, 
 " Sprechen sic Deutsch ? " She retorted, " Sprechen sie 
 Deutsch ? " In the words that she thus echoed, her 
 articulation was distinct, although the foreign phrases 
 were not repeated by her in quite so intelligible a manner 
 as the French. Not only did this woman echo all that 
 was said, but she imitated every gesture of those around 
 her. One of the pupils made a grimace ; she instantly 
 distorted her facial lineaments in precisely the same 
 manner; another pupil made the peculiar defiant action, 
 common in schoolboys, of putting the thumb to the nose, 
 and extending all the fingers — called in French, pied de 
 nez. The patient instantly imitated this elegant per- 
 formance. Just as we were leaving her bedside, a patient 
 in an adjoining bed coughed ; the cough was instantly 
 imitated by this human parrot ! In fact, this singular 
 
214 APHASIA, OR LOSS OF SPEECH. 
 
 old woman repeated everything that was said to her, 
 whether in an interrogative form or not ; and she imitated 
 every act that was done before her, and that with the 
 most extraordinary exactitude and precision.* 
 
 A few years ago, I saw, with Dr. McKelvie of Cromer, 
 a lady in whom the "echo sign" existed, not in connec- 
 tion with articulate speech, but with written language, 
 for when spoken to, she echoed in writing the words 
 addressed to her. 
 
 The subject of this peculiarity, Mrs. M., a distinguished 
 authoress, aged 72, a month previous to my visit, had an 
 attack of convulsions, which left her quite speechless, but 
 without any motor paralysis, the faculty of written 
 language remaining unimpaired. After a few days, it 
 was observed that, instead of answering questions, she 
 would repeat them in writing. Thus, on being asked, 
 " Had you any sleep last night ? " she took her pencil 
 and retorted, " Had you any sleep last night ? " She 
 was then remonstrated with thus, " Oh no, answer our 
 question : " she replied in writing, " Oh no, answer our 
 question." 
 
 It will be observed that in the above instance, the im- 
 pression made upon the auditory centre, stimulated the 
 centre for written language, and, as far as I know, this is 
 
 * In a French translation of my researches on Aphasia, which appeared 
 in several numbers of the " Gazette Hebdomadaire de Medecine " during 
 the years 1869 and 1870, the translator, M. Villard, gives some further 
 details about this patient, whose subsequent history he had the opportunity 
 of studying. He states that about five years after my own visit to her, she 
 became absolutely mute, and no longer echoed that which was said in her 
 presence ; she also ceased from imitating by gesture the acts of others, and 
 seemed to have merged into a state of indifference to all that was passing 
 around her. 
 
THE LANGUAGE OF PHYSIOGNOMY. 215 
 
 the only case on record in which imitative language took 
 the graphic instead of the phonetic form. 
 
 Kussmaul characterises this impulse of imitation as an 
 acoustic reflex, and says that the stimulus to the motor- 
 centre of sound originates in such cases in the acoustic 
 centre, which receives the words as an orderly succession 
 of sounds, and transfers them to the former.* 
 
 Dr. Winslovv, under the head of Morbid Imitation 
 Movements of Articulation, remarks that he has often 
 observed this echo sign at the commencement of acute 
 attacks of disease of the brain, particularly of inflamma- 
 tory softening ; this condition was observed after death 
 in a case reported by Romberg. -f- 
 
 When all other forms of language are either suspended 
 or perverted, there may still remain one, which is the 
 same in all countries and among all people — the lan- 
 guage of physiognomy: the aphasic may still evince 
 pleasurable sensations by a smile, give evidence of shame 
 by the blush on the forehead, and of fear by pallor of 
 the countenance.]: 
 
 * Die Storungen der Sprache, s. 55. 
 
 f " Diseases of the Nervous System," Sir E. Sieveking's Translation, Vol. 
 ii., p. 431. 
 
 \ The language of physiognomy has not been sufficiently considered by 
 writers on the localisation of the cerebral faculties. This subject is fully 
 developed by M. Albert Lemoine in his philosophical treatise entitled Li 
 Physionomie et la Parole, Paris, 1865. 
 
CHAPTER VII. 
 
 Varieties continued. Sensory Aphasia. Hearing and the cerebral 
 operations that follow impressions on the ear. Word-deafness — a purely 
 psychical and not an auditory defect ; may be confounded with insanity. 
 The perception of musical sounds may be abolished as well as that of 
 articulate language — Grant Allen on Note-deafness. Verbal amnesia. 
 Word-blindness — The psychology of Sight ; cortical blindness, psychical 
 blindness, and word-blindness. Pathology of Word-deafness and Word- 
 blindness — Experiments on animals by Ferrier, Schafer, and Sanger 
 Brown ; their conflicting results. Hemianopsia. Intermittent Aphasia. 
 Hysterical Mutism. 
 
 Sensory Aphasia. — Within the last few years, forms 
 of sensory aphasia have been described by Wernicke,* 
 to which Kussmaul subsequently gave the names 
 of Word-deafness and Word-blindness (Worttaubheit, 
 Wortblindheit). Although the writings of the above- 
 named authors have brought these morbid conditions 
 into more prominent relief, Dr. Bastian had previously 
 fully recognised the sensory nature of such defects ; and 
 although he had not endowed them with any special 
 name, these peculiar psychical disturbances, as well as 
 the important part played by commissural fibres between 
 the visual and auditory centres, were fully described, by 
 him.f 
 
 * G. Wernicke. " Der Aphasische Symptomencomplex. " Breslau, 
 
 1874. 
 
 f "On the Various Forms of Loss of Speech in Cerebral Disease." — 
 British and Foreign Medico- Chirnrgical Review, April, 1869, p. 482, &c. 
 
ON SENSORY APHASIA. 217 
 
 These peculiar forms of cerebral disturbance may be 
 considered as types of amnesic defect, in which that part 
 of the apperceptive faculty of speech in relation to the 
 senses of hearing 1 and of vision is disordered. It is 
 essentially the impressive or centripetal function that is 
 impaired ; the expressive or centrifugal function may 
 remain totally unaffected ; the patients have not lost the 
 power of speaking or of writing, but, although the hear- 
 ing is perfect, they are no longer able to understand the 
 words which they hear; and although vision is perfect, 
 they are unable to read and understand the written or 
 printed words which they see. In both of these forms, 
 it is the passive phase of the faculty of language that is 
 affected.* 
 
 * Whilst this chapter is passing through the press, my attention has 
 been called to an extremely interesting lecture on Sensory Aphasia, by Dr. 
 A. Hughes Bennett, in which he says that "it is through the senses, and 
 especially through those of hearing and sight, that the faculty of intellectual 
 language is acquired, and by which it is organised in the individual. The 
 association of the senses with the acquisition of speech is effected by certain 
 nervous elements, including the organs of sense, various conducting media, 
 and centres in the medulla and cortex cerebri. By sensory aphasia, there- 
 fore, is understood the results of interruption or disease of any of these 
 centripetal paths or centres which induce an imperfect appreciation of 
 language or its symbols, and which, as a consequence, may indirectly lead 
 to disorder of the faculty of expression. In addition to the sensoiy organs 
 themselves, and the complex nervous arrangements which connect them 
 with the surface of the brain, there must be other and more extensive 
 cerebral structures engaged in the acquisition or formation of speech. 
 These supply what has been termed the apperceptive faculties, or the 
 mental atlributes involved in the process of human intercourse or communi- 
 cation, the exact nature and locality of which is not accurately determined. 
 Therefore, on the sensory side, aphasia may arise either from disease of the 
 centres associated with the senses themselves, and especially those of hear- 
 ing and sight, or with a derangement of the nerve elements, whatever and 
 wherever they may be, which preside over the so-called apperceptive 
 
21 8 ON HEARING, AND THE CEREBRAL OPERATIONS 
 
 Although so much has lately been written about 
 Sensorial Aphasia, such conflicting opinions have been 
 enunciated by various authors, and the subject is still 
 involved in so much obscurity, that, before describing the 
 clinical symptoms of Word-deafness, I propose to make 
 a brief allusion to the philosophical treatise of M. Ballet, 
 which I think is calculated to elucidate this obscure 
 branch of cerebral pathology. 
 
 In an interesting chapter on the partial or total 
 effacement of the auditive images of words, Ballet 
 remarks that the cerebral operations that follow impres- 
 sions on the ear are of three kinds. I. The physical 
 perception of sound, which makes us conscious of it, and 
 permits us to appreciate in it certain general characters — 
 it is hearing properly so called. 2. The perception of 
 sound in the form of an image susceptible of reviving 
 the idea of a given object — it is the hearing of objects 
 and things. 3. The perception of a word, not only as a 
 sound or as a collection of sounds, but as a differentiated 
 sound capable of arousing the idea which it represents — 
 it is the hearing of words, or verbal hearing. 
 
 An example will enable us to recognise the funda- 
 mental differences between these three categories of 
 operations : — When a bell resounds in our ear, firstly, 
 we distinguish the sound which it produces, we perceive 
 vibration of which we were not conscious before the bell 
 rang — this is audition properly called ; secondly, from 
 the habit of hearing the bell, we recognise the sound as 
 
 faculty. This results in what has been termed respectively word-deafness, 
 word-blindness, and word-forgetfulness, or verbal amnesia, each being due 
 to disorder of the special nervous mechanism which originates and regulates 
 the corresponding function." — "Clinical Lectures on Diseases of the 
 Nervous System," British Medical Journal, Feb. iSth, 18S8. 
 
THAT FOLLOW IMPRESSIONS ON THE EAR. 219 
 
 that produced by a special object, a bell — here is 
 audition of objects ; thirdly, this same idea of a bell may 
 be aroused in our mind by a sound which is no longer 
 that of a bell, but that of a conventional word, which, by 
 education, we are accustomed to associate with the idea 
 of the object — this is verbal audition. Each of these 
 three forms of audition may be deranged separately, and 
 it is convenient, with Munk, to designate the complete 
 abolition of audition by the term cortical deafness 
 (Rindentaubheit) ; the abolition of the audition of objects 
 by the term of psychical deafness (Seelentaubheit) ; and 
 the loss of verbal audition by the term word-deafness 
 (Worttaubheit). 
 
 Thus a person affected with word-deafness will hear 
 the sounds, will be able to connect them with the object 
 which produces them, but will not understand the sense 
 of the words spoken. 
 
 A person struck with psychical deafness will hear the 
 sounds, but will be incapable of understanding the signi- 
 fication of these sounds, or that of the words. 
 
 A person struck with cortical deafness will not only 
 fail to understand the words, and to appreciate the 
 meaning of the sounds, but he will no longer hear the 
 sounds themselves.* 
 
 11. — Word-deafness. — This affection maybe defined as 
 an auditory amnesia, or loss of the memory of the signi- 
 fication and value of the articulated sounds which 
 constitute phonetic language. 
 
 The word-deaf is not deaf to sounds, and there is no 
 hindrance to the passage of impulses from the aural 
 
 * Gilbert Ballet. " Le Langage Interieur," pp. 75, 76, 77. 
 
220 ON SENSORY APHASIA. 
 
 apparatus to the cortex of the brain ; in fact, the auditive 
 sensitiveness is sometimes so acute that the patient is 
 susceptible to the slightest acoustic impression; he will 
 hear the ticking of a watch, and even the fall of a pin 
 upon a table ; his attention will be attracted to the noise 
 of the wind rushing through the trees, and when 
 whistling or noise of any other kind is made in his 
 vicinity, he will turn round with intelligent expression to 
 discover from whence the sound has emanated which has 
 been conveyed to his auditory centre. Word-deafness, 
 therefore, is a purely psychical defect ; the patient hears 
 what is uttered in his presence, but to him it is a con- 
 fused noise; the words used fail to revive in his memory 
 corresponding ideas, and the effacement of auditory 
 images is the pathogenetic condition of this singular 
 affection. 
 
 The following case, reported by M. Giraudeau, affords 
 an excellent and typical illustration of word-deafness, 
 and it is all the more interesting from the fact that 
 uncomplicated examples of this form of sensory aphasia 
 are comparatively rare, as this affection is commonly, if 
 not frequently, associated with word-blindness, and also 
 with more or less motor defect. The clinical history of 
 the patient comprises most of the symptoms which 
 recent writers mention as characteristic of word-deafness ; 
 and an additional interest attaches to this observation 
 from the fact that it was completed by a careful post- 
 mortem examination. 
 
 Marie Bouquinet, aged 40, a laundress, was admitted into the 
 L'Hupital Saint Antoine, under the care of Professor Hayem, on 
 February 22nd, 1882. In her antecedent history there was nothing 
 that pointed to syphilis or to intemperate habits. She had never 
 before been the subject of any disease ; she, however, had never 
 
ON WORD-DEAFNESS. 221 
 
 menstruated, and for three months had suffered from a constant 
 headache, affecting both sides of the head, with a nocturnal 
 exacerbation of such a character as to render sleep impossible, the 
 headache at times being so violent as to cause her to cry out from 
 the severity of the pain. She had never had vomiting, loss of 
 consciousness, or any epileptiform attack. 
 
 For upwards of a month before admission she was obliged to 
 give up work in consequence of the severity of the pain ; at about 
 the same time, it was observed, that she no longer understood what 
 was said to her, and that she did not answer when spoken to. 
 This information was obtained from the persons who accompanied 
 her to the hospital, as the patient was unable to supply it herself. 
 
 Condition on admission. — The patient is very stout, there is no 
 fever, the right pupil is slightly dilated, and there is severe head- 
 ache. When asked her name, she raises her head, but does not 
 answer. Asked a second time, she answers, " What do you say ?" 
 and on the same question being put a third time, she says, " I don't 
 understand." If she is asked a fourth time, she answers correctly, 
 " Marie Bouquinet." 
 
 On being asked, " How long have you been ill? " she evinces the 
 same difficulty of understanding, but replies, after a time, " Three 
 months." If she is asked to give her address, she replies, " Perhaps 
 for three months and a-half." Being interrogated as to her occu- 
 pation, she presents the prescriptions of the physician who treated 
 her in the town, and adds, "A white powder" (sulphate of quinine). 
 
 On several occasions we changed our mode of interrogation, but 
 the replies of the patient were always analagous to those mentioned 
 above. After having, with great difficulty, made her understand 
 a question by frequent repetition, she answers ; but, whatever sub- 
 sequent questions are put to her, she follows her first idea, and her 
 subsequent replies have no relation whatever to the questions put to 
 her. Sometimes, however, it is impossible to make her understand 
 our meaning at all, and to every question addressed to her she 
 invariably replies, " What do you say ? I don't understand. Cure 
 me." 
 
 Her hearing, however, is unaffected ; there is no discharge from 
 the ear ; she hears the ticking of a watch, and turns her head at 
 any slight noise made near her. Vision is good in both eyes, and 
 
222 ON SENSORY APHASIA. 
 
 there is no word-blindness, for she can easily read the headings of 
 the bed-ticket ; and to the question put to her, she replies verbally 
 or in writing, after a little reflection. Tactile sensibility is pre- 
 served, as well as the sense of taste and smell ; and the motor 
 power is unaffected. 
 
 Without entering into further details, suffice it to say that the 
 psychical affection rapidly increased, and on the ninth day after 
 her admission the word-deafness was complete, and whenever she 
 was addressed, she invariably said, " I do not understand," and 
 then began to weep. The next day she fell into a state of coma 
 and died. 
 
 At the necropsy, a sarcomatous tumour of the size of a walnut 
 was found occupying the posterior part of the first and second 
 temporo-sphenoidal convolutions of the left hemisphere ; the rest 
 of the brain being healthy.* 
 
 In the above history we have a typical instance of a 
 psychical trouble, characterised by an inability to under- 
 stand spoken words, although the organ of hearing itself 
 was unaffected. The names of objects and persons 
 uttered in the presence of the patient failed to revive in 
 her mind corresponding auditory images, showing that 
 the part of the apperceptive faculty of speech which is in 
 relation with the sense of hearing, was disordered. It 
 will be observed that, although the auditory impressions 
 of words were not revived, the visual and kinesthetic 
 memories were unaffected, for the patient could read, 
 speak, and write. 
 
 As it is only of late years that the pathology of word- 
 deafness has been understood, the subjects of it have 
 frequently been considered as deaf or demented. Bern- 
 hardt mentions an instance of a word-deaf consulting an 
 aurist, who, finding there was nothing the matter with 
 
 * C. Giraudeau. Note sur un cas de Surdite Psychique. Revue de 
 Medecine, 1882, tome ii., p. 446. 
 
WORD-DEAFNESS. 223 
 
 the auditory apparatus, referred him to Bernhardt, as 
 suffering from disease of the brain.* Baillarger f and 
 Wernicke J have both reported cases in which the 
 patients were regarded as insane; and as in word-deafness 
 there is frequently a certain amount of paraphasia, I 
 think it extremely probable that many suffering from 
 this affection have found their way to the lunatic asylum. 
 The careful clinical observer of the present day will 
 scarcely fall into this error, for, as Kussmaul says, " the 
 patients may have perfectly correct ideas, but the correct 
 expression for them is wanting ; the words, and not the 
 thoughts, are confused. They could even understand 
 the ideas of others, if they could only understand the 
 words. They are in the position of persons suddenly 
 set down in the midst of a population which uses the 
 same sounds but different words, these striking upon 
 their ears as an unintelligible jargon."|| 
 
 Sometimes the perception of musical sounds is 
 abolished as well as that of articulate language ; in 
 Bernhardt's case, already quoted, the patient was unable 
 to recognise well-known airs sung in his presence. Grant 
 Allen has reported a case in which the psychical defect 
 was exclusively musical : — 
 
 A young man, aged thirty, was the subject of the following 
 strange sensorial defect. If two adjacent notes upon a piano were 
 struck, he was quite incapable of perceiving any difference between 
 them ; after careful and deliberate comparison, he would declare 
 the two sounds to be exactly alike. If the same notes were sung 
 by the human voice, he was equally unable to discriminate between 
 
 * " Centralblatt fiir Nervenheilkunde " (1882). 
 
 t " Bulletin de l'Academie de Medecine," tome xxx., p. 828. 
 
 J " Der Aphasische Symptomencomplex," fall i., u. 2. 
 
 j| "Die Storungen der Sprache," s. 177. 
 
 P 
 
224 ON SENSORY APHASIA. 
 
 them. Further, if any note, say C, was played on the piano, and 
 another note at a considerable interval, say E or A in the same 
 octave, was subsequently played, he could not notice any difference 
 between them. As to his general capacity for hearing, he did not 
 seem to differ much from ordinary persons ; his power of dis- 
 tinguishing non-musical sounds was quite up to the average, and 
 his hearing was unusually acute. 
 
 Mr. Grant Allen, in commenting upon this strange history, says 
 that there are two facts in connection with it worthy of notice 
 for their wider psychological bearing. The first is, the absolute 
 indifference to the vast mass of musical sounds. If engaged in 
 mental work, and a German brass band, or a barrel organ were 
 grinding discord under his very ears, he would be quite uncon- 
 scious of the fact until his attention was called to it. Music, in 
 fact, under ordinary circumstances, quite escaped his observa- 
 tion. The second point is the converse aspect of the same 
 peculiarity. Whenever circumstances compelled his attendance at 
 a concert, a choral service, or a musical party, where no other occu- 
 pation was possible, this young man would suffer from the most 
 intense ennui, which became after a time almost insupportable. 
 The music being an absolute matter of indifference to him, the 
 effect was the same as if he were made to sit quietly in an attitude 
 for two or three hours, while nothing whatsoever was taking place. 
 Mr. Grant Allen characterises this singular defect as " Note- 
 deafness."* 
 
 From the description I have given of word-deafness, it 
 will be observed that it implies the complete loss of the 
 auditive images of words ; but akin to this affection there 
 is a slighter disorder, of which I have already given several 
 examples, in which the failure in the memory of auditive 
 representations was limited to substantives or to proper 
 names, &c, and to this form the name of Verbal 
 Amnesia has been given. Although, perhaps, there is 
 only a difference of degree between verbal amnesia and 
 word-deafness, the symptomatic aspect of the two affec- 
 
 * '-Mind," April, 1878, p. 157. 
 
VERBAL AMNESIA. 225 
 
 tions is widely different. With the amnesic, the idea of 
 an object or of an event is represented in consciousness, 
 but it fails to revive the corresponding word in his 
 memory ; but although he cannot spontajieously revive 
 his auditory images, if he is prompted and the proper 
 words are pronounced before him, the hearing of the 
 words will revive the dormant verbal image. A good 
 example of verbal amnesia was furnished by Sainty, 
 whose history I have reported amongst my own personal 
 observations (vide page 103). It will be remembered 
 that when shown a purse, and asked to say what it was, 
 he replied, " I cannot say the word ; I know what it is ; 
 it is to put money in." " Is it a knife ? " " No." " An 
 umbrella?" "No." "A purse?" "Yes." Here it 
 will be seen that he seized the meaning of the word as 
 soon as it was pronounced before him. It is quite 
 different with the patient afflicted with word-deafness ; 
 in vain his auditory centre may be stimulated by pro- 
 nouncing the proper words in his presence, the auditive 
 image has been completely effaced and exists no longer 
 in his brain, and no external influence can resuscitate it. 
 
 12. — Word-blindness is also a form of verbal amnesia 
 in which the patient has lost the memory of the conven- 
 tional meaning of graphic symbols. Vision is unimpaired, 
 the eye, as an optical instrument, is perfect, and the 
 ophthalmoscope will disclose no structural defect. The 
 patient sees the words, but no longer understands their 
 meaning, and he is exactly in the same position as if he 
 had never learnt to read ; but, strange to say, he can 
 write under dictation (that is, if there be no word- 
 deafness) ; he can even express his thoughts by writing, 
 but is incapable of reading what he has himself written. 
 
226 THE PSYCHOLOGY OF SIGHT. 
 
 I must once more refer to the extremely valuable 
 work of M. Ballet, who, in his chapter on Word-blindness, 
 or the partial or total effacement of the visual images 
 of words, establishes analagous distinctions to those 
 observed in Word-deafness, and under the generic term 
 of Word-blindness (La cecite verbale) he recognises the 
 following three varieties : — 
 
 1. Cortical blindness (La cecite corticate, Rindenblind- 
 heit) is the loss of the perception of luminous impressions. 
 
 2. Psychical blindness (La cecite psychiqiie, Seelenblind- 
 heit) is the loss of images commemorative of objects, 
 with at least partial preservation of luminous vision. 
 
 3. Word-blindness, properly called (La cecite' verbale, 
 Wortblindlieit), is the loss of the vision of words, or, in 
 
 general terms, of written symbols. 
 
 The form of cortical blindness that is observed 
 clinically is not a true blindness, inasmuch as it affects 
 only half the field of vision ; it is a liemiopia, and from 
 that portion of the field of vision which remains intact, 
 the patient continues to perceive the light, and one is 
 thus able to judge whether he recognises objects and 
 understands signs.* 
 
 A striking example of Word-blindness is reported by 
 M. Charcot. It formed the subject of one of the learned 
 Professor's celebrated lectures on Diseases of the Nervous 
 System, at La Salpetriere ; and as the patient was under 
 close observation for a considerable time, the clinical 
 symptoms could be studied under conditions exception- 
 ally favourable for physiological analysis. The follow- 
 ing is a brief summary of the most important features of 
 this interesting and classical case : — 
 
 * G. Ballet. Op. cit. p. 97. 
 
WORD-BLINDNESS. 227 
 
 A merchant, aged thirty-five, after unusual excitement in the 
 hunting-field, was suddenly seized with right hemiplegia and loss of 
 consciousness. The next day, on recovering consciousness, he 
 stammered in speaking, substituting one word for another. There 
 was a little paraphasia at this time, for his wife relates that he said, 
 " I have one hand in the sun " ; he recognised persons and objects, 
 but was unable to designate them by name. 
 
 At the end of three weeks the disturbance of speech had almost 
 entirely disappeared, and he would merely substitute occasionally 
 one word for another ; the hemiplegia had been gradually sub- 
 siding, and the motor power had so far returned in the hand, that 
 he could write very legibly. Now occurred the following extraor- 
 dinary incident. Wishing to give some order in reference to his 
 business affairs at home, he took a pen and wrote down his 
 directions ; then, thinking that he had forgotten something, he 
 asked to see the letter that he had just written, but he was unable 
 to read it, thus exhibiting in all its originality the strange phenome- 
 non, that he had been able to write, but was quite unable to read 
 his own writing ! He was also unable to read printed matter. 
 
 On analysing more closely the last-named symptom, it was 
 observed that he could write a long letter without any notable 
 mistakes in orthography. " I write," says he, " as if I had my eyes 
 shut ; I do not read what I write." In fact, he wrote quite as well 
 with his eyes closed. Having written his own name, he was asked 
 to read it. " I know very well," said he, "that it is my name that 
 I have written, but I can no longer read it." 
 
 A few days later another curious symptom was observed. Wish- 
 ing to try and play at billiards, he was able to grasp the cue 
 properly with his right hand, but he found he was unable to play ; 
 the inability depending on the fact that there was obscuration of 
 the right half of his visual field, for he could see only half the ball 
 that he was about to strike, and he lost sight of the balls altogether 
 as soon as their position corresponded to the right half of the field 
 of vision. He was, in fact, the subject of right-sided homonymous 
 hemianopsia. 
 
 From an analysis of the above clinical history, it will 
 be seen that the patient had lost all idea of the symbols 
 
228 WORD-BLINDNESS. 
 
 of written language from the receptive point of view ; 
 whilst he had retained the phenomena of auditive 
 reception, as well as those of graphic and verbal trans- 
 mission. 
 
 Dr. Ross, in a chapter on Sensory Aphasia, mentions 
 the case of a man, aged fifty-seven, the subject of 
 diabetes, who, when asked to read, would make very 
 elaborate preparations, and then utter a few sentences 
 which had not the remotest connection with anything 
 that was before him on the printed page. In speaking 
 of him, his wife volunteered the following information to 
 Dr. Ross. " He has given over attempting to read the 
 newspaper now," she said. " A short time ago," she 
 continued, " I hardly knew what to do with him. He 
 tried to read the newspaper, and he kept saying, ' I 
 don't know what is the matter with the papers now-a- 
 days, they are filled with such silly stuff.' I frequently 
 had to get him as many as four newspapers in a day, to 
 see if it would satisfy him. At last I was obliged to tell 
 him that it was not the newspapers that were wrong, but 
 that it was he who could not read ; and now he has given 
 over trying." This patient also had a right-sided 
 bilateral homonymous hemianopsia.* 
 
 The diagnosis of this affection may occasionally admit 
 of some difficulty; for instance, the remarkable case of 
 Dr. Osborne, that I have quoted at page 197, might at 
 first sight seem to be one of Word-blindness. When 
 asked to read from a book, he made use of strange and 
 totally unmeaning expressions, having no connection 
 whatever with the printed text; but it is evident that 
 his utterances were not in accordance with his mental 
 impressions, for Dr. Osborne clearly ascertained that, in 
 
 * Ross. "On Aphasia," p. 13. 
 
PATHOLOGY OF SENSORY APHASIA. 229 
 
 spite of the jargon he used, he really understood the 
 sense of what he was purporting to read. It is, more- 
 over, stated that he perfectly comprehended printed 
 language ; that he continued to read a newspaper every 
 day, and that, when examined, it was ascertained that he 
 had a very clear recollection of all that he had read, 
 notwithstanding that he would employ an unintelligible 
 gibberish, if asked to read it aloud. Such a case cer- 
 tainly ought not to be considered as one of Word- 
 blindness — a term that should be restricted to those 
 cases in which the patient does not appreciate the 
 meaning of printed or written words. 
 
 On analysing the condition of this patient, it will be 
 seen that the centripetal conducting paths of the receptive 
 department of the sensory function of speech were 
 unaffected ; it was the centrifugal function that was 
 impaired ; the disorder was not in the ingoing or im- 
 pressive function, but in the outgoing or expressive 
 function ; or, in other words, it was a motor defect, or 
 one of transmission. 
 
 Pathology. — Although so much has been recently 
 written about Word-deafness and Word-blindness, science 
 is not able to speak very dogmatically about the exact 
 seat of lesion in these affections, and we must rest con- 
 tented with a more or less probable hypothesis, as, 
 although the motor region of the cortex cerebri has been 
 mapped out with marvellous precision and exactitude, a 
 less satisfactory result has been attained in reference to 
 the localisation of sensorial centres. 
 
 In Word-deafness the lesion is generally supposed to 
 be in the first, and possibly also in the second, temporo- 
 sphenoidal convolutions of the left hemisphere, the sup- 
 
230 EXPERIMENTS ON ANIMALS J THE 
 
 posed centre for the auditory perception of words. The 
 first temporo-sphenoidal convolution was diseased in 
 every one of seventeen cases of Word-deafness collected 
 by Sepelli.* The researches of Schafer and Sanger 
 Brown, however, do not support the above localisation. 
 In six monkeys, they more or less completely destroyed 
 the superior temporal gyrus upon both sides ; and, in 
 one experiment, they separated up the fissures bounding 
 the gyrus, and scooped it out entirely from the very 
 bottom of the fissures, so that not a trace of the convo- 
 lution in question should remain. In all six cases the 
 result was the same ; hearing was not only not per- 
 manently abolished, but it was not perceptibly affected. 
 The animals, even immediately after recovering from the 
 anaesthetic, reacted to slight sounds of an unusual 
 character, such as a slight smacking of the lips or the 
 rustle of a crumpled newspaper. Some of them were 
 under observation for several months, and there was 
 never any doubt as to the full possession of their 
 auditory faculties. f 
 
 Dr. Bastian, who, with other writers, recognises a 
 general auditory centre, as well as an auditory word- 
 centre, leans to the localisation of the latter in the first 
 temporo-sphenoidal convolution ; and, in commenting on 
 the results obtained by Schafer and Sanger Brown, 
 remarks that experiments on monkeys are of a negative 
 character, and cannot be said to afford any definite 
 evidence against a presumption which is based upon 
 clinico-pathological evidence.* 
 
 * ■' Rivista Sperimentale di Freniatria," 1S84, p. 94. 
 
 f "Experiments on Special Sense Localisation in the Cortex Cerebri of 
 the Monkey," by E. A. Schafer, F.R.S.— Brain, Jan., 1S88. 
 
 J "On Different Kinds of Aphasia."— British Medical Journal, Oct. 
 29th, 18S7. 
 
AUDITORY AND VISUAL CENTRES. 23 I 
 
 In Word-blindness the lesion is located by most 
 observers in the angular gyrus and adjoining part of the 
 parietal lobule of the left hemisphere, but the most 
 conflicting results have been obtained by different 
 observers upon this point, and the precise localisation of 
 the morbid condition producing word-blindness has yet 
 to be established by subsequent clinical and post-mortem 
 evidence. 
 
 At one time Ferrier localised the visual centres in the 
 angular gyri, to the exclusion of the occipital lobes. In 
 his first experiments, antiseptics were not used; and hence 
 he says that some degree of inflammatory action and 
 consequent disturbance of the grey matter in immediate 
 relation with the actual lesion were unavoidable. In 
 his later researches with Professor Yeo, in which stringent 
 antiseptic precautions were employed, different results 
 seem to have been obtained. 
 
 From these experiments Ferrier draws the following 
 conclusions : — " That, though the occipital lobes are 
 included in the visual centres, it is nevertheless a remark- 
 able fact that they can be injured, or cut off bodily, 
 almost up to the parieto-occipital fissure, on one or both 
 sides simultaneously, without the slightest appreciable 
 impairment of vision That unilateral de- 
 struction of the angular gyrus produces only transient 
 loss of vision in the opposite eye ; and that even bilateral 
 destruction of the angular gyrus does not cause per- 
 manent total loss of vision. When, however, the angular 
 gyrus and occipital lobe are together destroyed in the 
 one hemisphere, transient amblyopia occurs in the 
 opposite eye, and more or less enduring hemiopia in 
 both eyes towards the side opposite the lesion, by reason 
 of paralysis of both retinae on the side corresponding to 
 
232 EXPERIMENTS ON ANIMALS. 
 
 the lesion. This condition of hemiopia, first pointed out 
 by Munk, has been erroneously attributed by him to 
 lesion of the occipital lobe alone, owing to the imper- 
 fection of his experimental methods." Further on, 
 Ferrier summarises his views as follows: — "It appears 
 to me, therefore, that, in addition to the representation 
 of the correlated halves of both retinae in the correspond- 
 ing occipito-angular region, the angular gyrus is the 
 special region of clear or central vision of the opposite 
 eye, and perhaps, to some extent also, of the eye on the 
 same side."* 
 
 The recent researches of Professor Schafer and Dr. 
 Sanger Brown have given different results, and do not bear 
 out Ferrier's conclusions. These physiologists destroyed 
 in a monkey the angular gyrus, first on one side and then 
 on the other, without any appreciable defect being pro- 
 duced, either in the animal's " visual perceptions, or its 
 ocular movements, or in the sensibility of the globe of 
 the eye." This animal was kept for several months, and 
 submitted to careful and general observation, and was 
 also exhibited at a recent meeting of the London 
 Neurological Society. 
 
 As it might be objected that although the cortex of 
 the angular gyrus had been destroyed right up to the 
 fissures bounding it, still some portion might have been 
 left at the bottom of these fissures, it was determined in 
 another animal to make a complete removal of the gyrus 
 angularis in its whole depth and extent. The lips of the 
 fissures were accordingly separated, and the entire gyrus 
 angularis of one side was scooped away, producing 
 thereby a gap in the surface of the brain of considerable 
 
 * '• Functions of the Brain," 2nd edition, pp. 273, 284, 2S8. 
 
EXPERIMENTS ON ANIMALS. 233 
 
 depth. This operation was followed by a disturbance of 
 visual perceptions ; but the disturbance was not ambly- 
 opic, it was distinctly hemiopic; this condition having 
 lasted for a few days only, gradually passed off, leaving 
 vision unimpaired. 
 
 These observers then continued their experiments on 
 the occipital lobe, which they entirely removed by a 
 vertical incision carried along the line of the parieto- 
 occipital fissure, leaving intact the angular gyrus. The 
 result was the immediate establishment of a permanent 
 bilateral homonymous hemianopsia, which persisted 
 during the whole time that the monkey was kept alive. 
 Objects so placed that their images fell upon the left 
 half of the retinas, were taken no notice of; a threatened 
 blow coming from the right-hand side of the mesial 
 visual plane was not winced at or avoided ; currants 
 strewn upon the floor were only picked up towards the 
 left side, the animal working round in that direction. 
 In another monkey both occipital lobes were removed, 
 leaving the angular gyri intact; the result was total and 
 persistent blindness. The animal could only find food 
 by groping and smelling ; brought into a strange place, 
 it ran against every obstacle ; placed in a dark room, 
 and with light flashed upon it, no signs of perception 
 were given. 
 
 Schafer, in commenting on the above experiments, 
 suggests that the opposite results obtained by Ferrier, 
 who removed both occipital lobes without any symptoms 
 of defective visual perception, were due to the fact that 
 the removal was incomplete.* 
 
 Dr. Gowers, in his recently published work, speaks 
 very positively as to the point in dispute in reference to 
 
 * Schafer. Op. cit., pp. 3, 5, 7. 
 
234 T1J -E HIGHER VISUAL CENTRE. 
 
 the visual centre. " Numerous observations," he says, 
 "have established beyond question the fact that hemia- 
 nopia results from disease of the optic lobe, which thus 
 constitutes a centre for the fibres from the same-named 
 half of each retina, and receives impressions from the 
 
 opposite half of each field of vision But 
 
 disease sometimes causes, not hemianopia, but 'crossed 
 amblyopia/ i.e., dimness of sight in the opposite eye, 
 generally with concentric diminution of the field. The 
 theory which best explains the fact is that on the outer 
 surface, in front of the optic lobe, there is a higher visual 
 centre, in which the half fields are combined, and the 
 whole opposite field is represented. Such a centre in 
 animals is localised by Ferrier in the angular gyrus (in 
 which term he includes the extremity of the supra- 
 marginal convolution). Pathological evidence in man 
 points to some part of the same region as the seat of this 
 centre."* 
 
 * " Diseases of the Nervous System," Vol. II., p. 18. It will be observed 
 that Dr. Gowers actually uses the word optic in speaking of the occipital 
 lobe. In further pursuance of this subject, he elsewhere remarks "that the 
 part of the brain concerned in the perception of visual word-symbols seems 
 to be in the lower and hinder part of the parietal lobe, also on the left side 
 of the brain. Disease of this part has caused inability to read even the 
 simplest word, a condition that has been termed 'word-blindness.' Of the 
 cases recorded by Sepelli, in each one in which word-blindness co-existed 
 with word-deafness, the disease extended into this part of the parietal lobe. 
 This region, as we have seen, is probably the seat of the ' higher visual 
 centre,' and transient 'mind-blindness' has been caused by its disease, i.e., 
 
 an inability to recognise not only words, but objects also We 
 
 have seen that the visual path passes on each side by the optic tracts to the 
 optic thalamus, and thence by the optic radiation to the cortex of the optic 
 lobe. This constitutes a half-vision centre which seems to be double, for 
 light and for colours. The two half-vision centres are probably blended in 
 a higher visual centre in front of the optic lobe. The arrangement, how- 
 ever, is very complex ; in each centre both fields are represented, but 
 
ERRATUM, p. 234. 
 
 The Author wishes to call attention to an oversight in 
 transcribing from Dr. Gower's work — the word "optic" has 
 inadvertently been subst'tuted for "occipital." In con- 
 sequence of this error, the comment upon the word "optic" 
 in the foot-note becomes a mis-statement. 
 
CHAUFFARD, PFLUGER, SKWORTZOFF. 235 
 
 At the moment of writing the above lines, my atten- 
 tion has been called to an important communication by 
 M. Chauffard, in which he gives a detailed account of 
 sudden blindness occurring in a patient under his charge, 
 where, after death, there was found lesion of both occi- 
 pital lobes.* In the same article, amongst various other 
 similar instances, M. Chauffard quotes the following, as 
 he terms it, experimental case, reported by Pfliiger in the 
 Berliner klinische Wochenschrift for 1885 : — A young 
 man received a gunshot wound in the occipital region, 
 and was struck with sudden blindness ; death occurred 
 on the 39th day, and the autopsy revealed extensive 
 lesions of both occipital lobes, in which a certain number 
 of shots had lodged. 
 
 Amongst the different writers on this subject, I must 
 not omit Dr. Nadine Skvvortzoff, who, in summarising the 
 results of various observers, says that although differences 
 of opinion exist as to the precise seat of the visual centre, 
 they all admit that this centre is in the posterior part of 
 the brain, and that it does not extend in front beyond 
 the gyrus angularis.f 
 
 chiefly that of the opposite eye. Each higher visual centre can supplement 
 its fellow to some extent and compensate its loss, but in the half-vision 
 centres there is no power of supplemental action, and no compensation for 
 loss is possible. ... In connection with the interference of the higher 
 visual functions of the brain., it may be noted that the area of the cortex, 
 which is apparently related to these functions, is very extensive. In no 
 part of the brain is the difference greater between the brain of the monkey 
 and that of man than in this region, between the extremity of the fissure of 
 Sylvius and the optic lobe. This region in man exceeds in size the whole 
 of the brain of the monkey." — Pp. 104, 133, 151. 
 
 * Chauffard. De la Cecite Subite par lesions combinees des deux lobes 
 occipitaux (Anopsie corticale). Revue de Medecine, Fevrier, 1SS8, p. 131. 
 
 t " De la Cecite et de la Surdite des Mots." — VEnceJ)hak, Oct., 1881, 
 P . 215. 
 
236 HEMIANOPSIA. 
 
 It will be observed that the two cases of word-blind- 
 ness that I have quoted were complicated by right- 
 sided bilateral hemianopsia, a symptom frequently 
 associated with word-blindness. According to the recent 
 researches of M. Charcot, who has investigated this 
 subject very minutely, it would seem that in hemianopsia 
 of cortical origin, the lesion occupies nearly the same 
 region as in word-blindness. M. Charcot, however, 
 expresses this opinion with a certain amount of diffi- 
 dence, observing that if word-blindness and hemianopsia 
 had precisely the same seat in the brain, the two clinical 
 phenomena should be always associated, which seems 
 not to be the case, as cases can be quoted of hemianopsia 
 without word-blindness, and also of word-blindness with- 
 out hemianopsia.* 
 
 Dr. de Watteville, after stating that word-blindness is 
 sometimes accompanied by hemianopsia, and at other 
 times unattended by any visual trouble, remarks that the 
 post-mortem results in this affection are not identical ; 
 the lesion, according to him, occupying sometimes the 
 angular gyrus, and at others the first temporal convolu- 
 tion. He explains the occasional dissociation of word- 
 blindness and hemianopsia, by recognising that the 
 former may arise from three distinct and separate causes : 
 lesion of the visual centre ; lesion of the auditory centre ; 
 and lesion of the audito-visual commissure. In the last 
 two instances no hemianopsic trouble can complicate the 
 word-blindness, which can only appear in all its purity 
 when the lesion affects the commissure. f 
 
 The diametrically opposite conclusions at which 
 different physiologists have arrived, leave the question 
 
 * Charcot. Maladies du Systeme Nerveux, tome iii., p. 171. 
 f Le Progres Medical, 21 Mars, 1885. 
 
PATHOLOGICAL LESIONS. 
 
 237 
 
 of the localisation of the lesion in Sensory Aphasia still 
 undecided ; the accompanying plate, however, may be 
 deemed to represent approximately, if not with absolute 
 accuracy, the views of the majority of the writers on 
 this obscure branch of cerebral pathology. 
 
 External suifacc of the left hemisphere of the Brain. 
 
 (After Ross.) 
 
 R — Fissure of Rolando ; Sf— Fissure of Sylvius ; zj#/^Interparietal fissure ; 
 pof— External parieto-occipital fissure ; F lt F„, and F s — The first, second, and 
 third frontal convolutions ; A and B — The ascending frontal and parietal con- 
 volutions respectively ; T lt T 2 , and T s — The first, second, and third temporo- 
 sphenoidal convolutions ; O x , 2 , and 3 — The first, second, and third 
 occipital convolutions ; P x — The superior parietal lobule ; P„ — The inferior 
 parietal lobule ; P 3 — The angular gyrus. The shaded part on F 3 corresponds 
 to the localisation of the lesion in aphemia ; on F 2 to motor agraphia ; on 7\ 
 to word- deafness ; on T 2 and 7" 3 to verbal amnesia; and on P % and P & to 
 word-blindness. 
 
 I need scarcely say that experiments on animals are 
 utterly worthless for elucidating the theory of word- 
 blindness ; and even in reference to the visual centre 
 itself, the results obtained from observations on animals 
 
238 INTERMITTENT APHASIA. 
 
 can scarcely be considered as rigorously applicable to 
 man. 
 
 Although the evidence of those who have investigated 
 the subject is of a most conflicting character, it must be 
 conceded that the general consensus of opinion places 
 the lesion in Sensory Aphasia in the area of distribution 
 of the parieto-sphenoidal and sphenoidal branches of the 
 left middle cerebral artery; but the contradictory opinions 
 now prevalent as to precise localisation, can only be 
 reconciled by more extensive and accurate clinical and 
 pathological records. 
 
 13. — I have quoted several cases in which the aphasia 
 was of an intermittent character, and the patients 
 regained the power of speech as suddenly as they lost it. 
 The clinical history of R. Dalliston, which I have detailed 
 at great length (page 136), is a good illustration of this 
 form, as also the following observation recorded in 
 V Encephale for March, 1883, the subject of it being a 
 medical practitioner : — 
 
 A provincial physician, previously in the enjoyment of excellent 
 health, was summoned to a patient at some considerable distance 
 from his own house ; and whilst traversing a forest, he wished to 
 inquire his way of some wood-cutters whom he met, when he found 
 he was unable to articulate a single intelligible word. No pre- 
 monitory symptoms ushered in this sudden attack of aphasia ; he 
 had experienced no feeling whatever of discomfort, and had hitherto 
 been free from any bodily ailment, except occasional attacks of 
 migraine. 
 
 A few minutes before the attack he felt tingling and convulsive 
 twitchings in the right hand, and, as he was driving, the reins fell 
 from his hand. Being alarmed, he quickly returned home, but was 
 unable to tell his wife what had happened. He then made a sign 
 that he wished to write, but when pen, ink, and paper were brought 
 to him, he found himself as incapable of expressing his thoughts by 
 
INTERMITTENT APHASIA. 239 
 
 writing as by articulate speech. After several fruitless attempts, he 
 succeeded in pronouncing the word "blood." This was understood 
 by the bystanders that he wished to be bled, and twenty leeches 
 were applied to the anus. He then lost consciousness, and was 
 seized with epileptiform convulsions, followed by a state of coma 
 which lasted several hours. On recovering consciousness he could 
 say a few words ; the speech gradually improved, and forty-eight 
 hours after the commencement of the seizure, he spoke as well as 
 ever, and there remained no trace whatever of this singular attack. 
 About a month afterwards this gentleman had a recurrence of 
 the above symptoms, the aphasia, however, lasting only twenty 
 minutes. During the next three years he had twenty-nine similar 
 attacks, varying in duration from ten minutes to several hours, and 
 on two occasions lasting over twenty-four hours. In almost every 
 instance there was more or less tingling and convulsive movement 
 of the right arm. During the interval between these attacks the 
 patient enjoyed excellent health, with the exception of occasional 
 headaches, to which he had been subject nearly all his life. 
 
 Professor Ball, the editor of V EnccpJiale, in comment- 
 ing upon the above singular clinical history, says that 
 the marked intermittence of the symptoms, and their 
 exceedingly short duration, are irreconcilable with a 
 diagnosis of organic lesion; and in the absence of any 
 appreciable disease of the heart or blood vessels, he 
 considers the morbid condition to be the result of 
 functional cerebral ischaemia, and in support of this view 
 he calls attention to the fact that a remarkable aggrava- 
 tion of the symptoms resulted from the application of 
 leeches, which caused a still greater impoverishment of 
 the blood. 
 
 14. — There is a variety of aphasia characterised by 
 this peculiarity — that although the subjects of the affec- 
 tion can articulate nothing else whatever, they can give 
 vent to an oath ; and thus, in the heat of passion or 
 
 Q 
 
240 AUTOMATIC UTTERANCES UNDER EMOTION. 
 
 excitement, they give spontaneous or automatic utterance 
 to words or phrases expressive of strong emotion — 
 ejaculations not always correct as regards taste or ethics, 
 and which the patient is wholly unable to reproduce when 
 the stimulus of emotion is wanting. It would thus seem 
 that the capacity for producing words for the purpose of 
 expressing thought may be lost, while the capacity for 
 uttering interjectional words may be retained. 
 
 I have already incidentally alluded to a case of Dr. 
 Hughlings Jackson, in which the patient had recovered 
 the power to swear, although continuing aphasic.* Dr. 
 Gairdner mentions the case of a patient in the Edinburgh 
 Royal Infirmary whose sole means of communication with 
 others was by signs. After a time, Dr. Gairdner noticed 
 that the other patients believed he was shamming, and, 
 on inquiry, they gave as a reason for their opinion, that 
 he could swear. The man shortly afterwards died sud- 
 denly, when his brain was found to be the seat of a large 
 number of minute deposits of cancer.f 
 
 Dr. Hughlings Jackson hints that these oaths and 
 interjectional expressions as observed in aphasic patients, 
 may be due to reflex action, and he goes on to say : — 
 " It is quite obvious that they are not voluntary, as the 
 patients cannot repeat the phrases. The will cannot act, 
 but somehow an emotion, e.g., anger, gets the words 
 passed through the convolution of language. Just as a 
 paralysed foot will jump up when the sole is tickled, so 
 these words start out when the mind is excited. Such 
 ejaculations seem to have become easy of elaboration by 
 
 * Hughlings Jackson locates the automatic power of uttering words in 
 the right hemisphere, and the voluntary power in the left. Kuss'maul 
 combats, and I think successfully, this hypothesis. 
 
 + "On the Function of Articulate Speech," p. 14. 
 
HYSTERICAL MUTISM. 24 1 
 
 long habit, and require but slight stimulus for perfect 
 execution."* 
 
 15. — Aphasia is not an uncommon accompaniment of 
 hysteria ; the onset of the symptom being usually 
 sudden, and its duration extremely uncertain, the loss of 
 speech varying from a few minutes to several days, or 
 even months. 
 
 Dr. Graves has quoted a case observed by Dr. Richter, 
 of Wiesbaden, of an hysterical female who regularly 
 became speechless every day at four o'clock, p.m. ; con- 
 sciousness did not appear to be at all impaired, but there 
 was a feeling of weight about the root of the tongue, and 
 the paroxysm went off with a large evacuation of watery 
 urine, accompanied by perspiration and sleep. This 
 periodical aphasia was cured by large doses of quinine. f 
 Another most striking instance of the connection between 
 loss of speech and hysteria is recorded by Dr. Wells, the 
 subject of it being a woman aged forty-three, who had 
 been subject to fits of an hysterical character for a long 
 time ; on recovery from one of these she found herself 
 entirely deprived of the power of speaking, or even of 
 making any noise whatsoever with her voice, though she 
 was at the same time in full possession of every other 
 faculty, both mental and bodily; strange to say, her 
 recovery of speech coincided with the occurrence of the 
 next hysterical fit, which took place ten days later. J 
 
 In the "Progres Medical," No. 9, 1876, Louiville and 
 Debove describe the case of a girl, eighteen years of age, 
 who, in consequence of hysterical paralysis of the vocal 
 cords, became at length quite dumb. The authors, by 
 
 * London Hospital Reports, Vol. i., p. 454. 
 
 + "Dublin Journal of Medical Science," Jan., 1834, p. 419. 
 
 J " Medical Communications," Vol. ii., p. 501. London, 1790. 
 
242 HYSTERICAL MUTISM. 
 
 firm and painful pressure in the region of the ovaries, 
 produced a well-marked hysterical paroxysm. During 
 the attack, the patient, for the first time after a long 
 period, began to scream and to speak with a low voice. 
 Repetition of the procedure brought back the voice 
 entirely, but the disordered condition of the nervous 
 system remained. 
 
 Kussmaul cites the case of a lady, aged thirty-one, 
 who was the subject of hysteria, and who suffered from 
 paralysis of the legs and of the left arm. At intervals 
 she lost the power of speech for hours and days at a 
 time ; but pressure on any spot in the lateral regions of 
 the neck always relieved the aphasia immediately.* 
 
 Hysterical mutism formed the subject of one of M. 
 Charcot's classical lectures at La Salpetriere. The 
 clinical history upon which he founded his remarks was 
 that of an artisan, aged thirty-three, who, up to the age 
 of thirty, had been subject to attacks of a hystero- 
 epileptic character. He married, and these attacks 
 ceased. Shortly afterwards, without any known cause, 
 other than laryngitis accompanied by aphonia, he sud- 
 denly became mute. He could neither speak, phonate, 
 or whisper, although able to move his tongue and his 
 lips in every direction ; he was, however, able to convey 
 his thoughts in writing. At the end of some weeks 
 his speech suddenly returned, after the use of the 
 laryngoscopic mirror ! A few weeks later on, the mutism 
 was reproduced during a fresh attack of laryngitis. 
 
 M. Charcot, in commenting upon this case, remarks 
 that the affection is essentially of a dynamic nature, and 
 in analysing the symptoms observed in hysterical 
 
 * Op. cit., p. 201. 
 
HYSTERICAL MUTISM PRODUCED BY HYPNOTISM. 243 
 
 mutism, he lays stress on the inability to whisper. 
 Whispering, he says, is nothing but a spoken and articulate 
 language, and is absolutely independent of the laryngeal 
 voice; Marey in 1876, and Boudet in 1879, having by 
 their experiments established that in whispering the 
 larynx takes no part, the vocal cords not entering into 
 vibration ; the air traverses the larynx in the same 
 manner as it passes through the trachea, as through an 
 inert tube. 
 
 Although the patients have retained the entire use of 
 the common movements of the tongue and lips, and are 
 able to move these organs with agility in all directions, 
 so as to be able to whistle, they are totally unable to 
 articulate a single word even in a whisper. They are 
 mute, in the rigorous sense of the term ; in fact, they are 
 more than mute, for whilst it is possible for the deaf- 
 mute to make various noises, the hysterical mute is 
 voiceless. 
 
 Hysterical mutism, it would seem, can be produced 
 artificially by hypnotism. The patient being plunged 
 into the somnambulistic period of hypnotism, M. Charcot 
 begins by talking to her for a few seconds ; then getting 
 nearer to her, he pretends neither to hear her or to 
 understand her, and tells her that she cannot speak. 
 The patient soon becomes aphasic and voiceless (aphone), 
 showing signs of distress at not being able to answer 
 questions.* 
 
 Sometimes spasmodic mutism coincides with hysterical 
 trismus, as in two instances mentioned by Dr. Bright.f 
 
 Some years since, a girl, eleven years of age, was 
 admitted under my care. into the Norfolk and Norwich 
 
 * Charcot. " Maladies du Systeme Nerveux," tome iii., p. 422. 
 
 t '-Bright's Reports of Medical Cases," Vol. ij., part 2, pp. 459, 460. 
 
244 SPASMODIC MUTISM. 
 
 Hospital, who, after exposure to cold and damp, was 
 brought to the institution because her mother found she 
 was unable to speak. On examining her, it was found 
 that there was a forcible closure of the lower jaw ; but 
 the moment the mouth was pressed open she could 
 speak as before. 
 
 I formerly attended the widow of an eminent physi- 
 cian, who would sit for hours together with the head 
 forcibly extended on the cervical spine, and who whilst 
 in this position never spoke a word. The intellectual 
 powers of this lady were unimpaired. 
 
 "There is," says Dr. Bergmann, "a fixity of thought, 
 as well as a flight of thought, an intellectual catalepsy 
 and chorea." The same may be said of the process by 
 which these thoughts are communicated to the outer 
 world, for it would seem that loss of speech may occur 
 as a cataleptic symptom, and Dr. Todd, in writing about 
 a case analogous to those mentioned above, uses the 
 term catalepsy in his description of it. 
 
 A curious case of a similar nature is recorded by 
 Willis, which he calls "paralysis spuria." His descrip- 
 tion is so quaint that I am tempted to transcribe it : — 
 "Curo jam nunc fceminam prudentem et probam, quae 
 per plures annos hujusmodi spuriae paralysi non tantum 
 in membris sed etiam in lingua obnoxia fuit ; hsec per 
 tempus quoddam libere et expedite satis loquitur, post 
 sermones tamen longos, aut illos festinanter et laboriose 
 prolatos, illico sicut piscis obmutescens, amplius ne gry 
 quidem proloqui potest, porro nee nisi post horam unam, 
 aut alteram vocis usuram ullam recuperat."* 
 
 * Op. T. Willis, M.D., " De Paralysi, De anima. Brutorum," cap. ix., 
 p. 149- 
 
CHAPTER VIII. 
 
 Etiology of Aphasia. May be congenital ; deaf-mutism ; the loquelar 
 defect in Idiots — Dr. Kerlin's statistics. May be the result of exostosis of 
 the cranial bones ; of thrombus of the cerebral arteries ; of tumours or 
 abscess in the brain, &c. Dr. Macewen on the Surgery of the Brain. 
 Gowers on irritative inhibition. Traumatic Aphasia, or loss of speech 
 caused by direct injury to the brain — Baron Larrey, Simon, &c. ; three 
 cases observed by the author. Loss of speech the result of vaso-motor 
 paralysis ; of atmospheric changes ; of the action of certain drugs ; of 
 simple molecular disturbance of the brain cells ; of the bite of venomous 
 snakes, &c. Puerperal Aphasia. 
 
 Having noticed the different forms in which loss or 
 lesion of the Faculty of Articulate Language is met with 
 by the clinical observer, I now propose to consider the 
 various causes which give rise to this morbid symptom. 
 
 The study of the etiology of any disease affords one 
 of the best clues to a clear knowledge of its nature and 
 probable course ; and as the pathology of aphasia is 
 involved in so much obscurity, it seems especially 
 desirable carefully to review the various circumstances, 
 physical and moral, under which defects in the power of 
 speech have become developed. 
 
 Some may think that it is illogical to attempt any 
 systematic classification of the causes which may induce 
 what I admit is only a symptom ; but it seems to me that 
 there is a practical convenience in studying aphasia from 
 an etiological point of view, as furnishing a pivot around 
 which to group, with something like method, our positive 
 knowledge of this intricate subject. 
 
246 THE ETIOLOGY OF APHASIA. 
 
 Causes. — A variety of morbid conditions may produce 
 loss or lesion of the faculty of speech. 
 
 I. — It may be congenital, as in the deaf and dumb ; 
 although, strictly speaking, the silence of the deaf-mute 
 is not true mutism ; for when deafness is congenital, or 
 occurs at an early age, the inability to speak is due 
 simply to the fact that the child cannot by the usual 
 means be taught to employ words or construct sentences 
 — in fact, he is simply deaf, the ear only being at fault ; 
 the organs of voice and speech are in their normal con- 
 dition, and are quite capable of being roused into action, 
 and he would speak if only he could hear; in fact, the 
 causes of deaf-mutism differ in no respect from those of 
 ordinary deafness, except that they come into operation 
 during intra-uterine life or during childhood.* 
 
 It may therefore be said that the child is not born deaf 
 
 * Kussmaul has an interesting chapter on deaf-mutism, in which he says 
 that the age of puberty is the latest period of life at which deafness can 
 deprive persons of the power of speech which they had already acquired. 
 
 In most of the cases of deaf-mutism acquired after birth, this infirmity is 
 developed during the first four years of life ; from that period to the tenth 
 year the cases become progressively less numerous, and those in which it is 
 developed between the tenth and fourteenth years are exceedingly rare. 
 Previous to puberty the word-pictures (Wortbilder) have not made so 
 lasting an impression on the memory as is the case at a later period, when 
 deafness, although it may seriously impair the pictures (Bilder), is no 
 longer able to efface them altogether. 
 
 Kussmaul also gives some curious statistics in reference to deaf-mutism, 
 which, he says, is more common in males than in females, and more 
 frequently met with in country districts than in cities ; and, strange to say, 
 it is incomparably more frequent among Jews than Christians. In Nassau, 
 in the year 1864, the proportion of deaf-mutes amongst the Jews was 
 1 to 508, whilst among the Catholics it was only 1 in 1,397, and among 
 the Protestants I in 1,101 ; in the department of Cologne, in the year 1869, 
 the proportion was — Jews, 1 in 560; Catholics, 1 in 1,814; and Protes- 
 tants, 1 in 2,638. — "Kussmaul Die Storungen der Sprache," s. 259, 262. 
 
ON DEAF-MUTISM. 247 
 
 and dumb, but that dumbness is really due to the want of 
 education of the faculty of speech, and not to its absence ; 
 for deaf children are quite as capable of articulation as 
 those who can hear, provided they are not the subjects 
 of any intellectual incapacity. As a proof of this, I may 
 cite the remarkable progress lately made in the educa- 
 tion of deaf-mutes, who are now taught to watch with 
 the eye the motion of the tongue and of the lips of those 
 who speak to them ; and thus by imitating the inaudible 
 mechanism of the lips and tongue of the speaking 
 person, they are able to emit articulate sounds — in fact, 
 to speak. 
 
 When the loss of hearing is dependent on congenital 
 causes, a less amount of deafness will prevent the first 
 development of speech than would be necessary to arrest 
 it when once the faculty has been acquired ; moreover, 
 those who are born deaf and dumb are less susceptible 
 of improvement than those who have become deaf in 
 early childhood and have consequently lost the power of 
 speech ; these last, who should not strictly be called 
 deaf-mutes, are much more amenable to treatment, and 
 sometimes quickly recover what they had lost. 
 
 M. de Font-Reaulx has published the history of a 
 deaf-mute, who died at Bicetre at the age of sixty, and 
 at whose autopsy there was found a remarkable atrophy 
 of the island of Reil on both sides, especially on the left ; 
 the brain itself, however, was very large, with its convo- 
 lutions particularly well developed, the entire encephalon 
 weighing 1,620 grammes (57 ounces).* This observation 
 is of extreme interest as contrasting with the micro- 
 cephalic brains to which I shall allude hereafter. 
 
 * " Localisation de la faculte speciale du Langage Articule," p. 99. 
 
248 ON DEAF-MUTISM. 
 
 Dr. Llewelyn Thomas has recorded the case of a child 
 who, after an attack of convulsions at the age of three 
 years and a half, became dumb, and on examination the 
 child was found to be also absolutely deaf.* 
 
 A striking illustration of the possible association of 
 deafness with aphasia has been furnished by Mr. Glisson 
 in the British Medical Journal for August 18th, 1875. 
 The patient, a boy four years and a half old, was brought 
 to Mr. Glisson for a skin affection, when his mother 
 stated that at the age of eighteen months the child met 
 with a fall, which resulted in a contusion of the skin and 
 a small tumour in the left temporal region. Before the 
 accident, he was just commencing to prattle a few simple 
 monosyllables, but since he fell he had not been able to 
 speak, and had scarcely ever tried. Now, it is not stated 
 whether the boy was deaf, but as the injury was in the 
 immediate neighbourhood of the temporo-sphenoidal 
 convolution, it is highly probable that the auditory 
 centre was damaged, or possibly some inflammatory 
 process was set up in the internal ear itself. 
 
 The study of the muteness of the deaf is a subject well 
 worthy of the careful investigation of those members of 
 our profession who have the medical charge of institu- 
 tions for the deaf and dumb, for it is now recognised that 
 this infirmity is partly remediable ; in fact, a noted 
 French writer upon this subject says "ii est possible de 
 donner la parole a la plus grande partie des sourds- 
 muets, car c'est le plus petit nombre, c'est l'exception 
 qui presente des vices primordiaux ou acquis de l'appareil 
 vocal. "f 
 
 * British Medical Journal" Sept. 18th, 1875. 
 
 f "La Surdi-Mutite, par Dr. Blanchet, Chirurgien de l'lnstitut National 
 des Sourds-Muets," torn, ii., p. 12. 
 
DEFECTS OF SPEECH IN IDIOCY. 249 
 
 2. — Aphasia is one of the frequent symptoms of idiocy 
 and Esquirol actually based his classification of idiots 
 upon the power of speech which they possess. In the 
 first degree, the idiot, according to him, uses mere words 
 and short phrases; idiots of the second class articulate 
 only monosyllables or certain cries ; finally, in the third 
 degree of idiocy, there is neither speech nor phrases, 
 neither words nor monosyllables. The case of G. van A., 
 which I have quoted from Van der Kolk, may be con- 
 sidered as a good illustration of Esquirol's third variety. 
 The subject of the loquelar defects in idiots is treated in 
 a masterly manner by Dr. Wilbur, Superintendent of the 
 New York State Asylum for Idiots, to whose interesting 
 treatise I would refer for more complete information on 
 this point.* 
 
 Dr. Kerlin, the Superintendent of the Pennsylvania 
 Institution for Idiots, in a statistical table of one hundred 
 idiot children, records 20 as aphasic ; and of these 20 
 children, 2 were epileptic, 7 paretic, 9 choreic, 8 micro- 
 cephalic or demi-microcephalic, and 3 hydrocephalic. 
 Dr. Kerlin also gives the aggregates of orphanage, grade, 
 condition, and parental and grandparental antecedents of 
 these children. 
 
 It is important not to confound the aphasia of the 
 confirmed idiot with ordinary deaf-mutism ; for, as 
 Duncan and Millard remark, the deaf and dumb children 
 of uneducated parents, whose social position entails want 
 and much misery, are often so low in their mental power 
 that they cannot be distinguished from idiots before they 
 attain the age of five or six years ; and when they have 
 the misfortune to have a halt in their gait, or an unusual 
 
 * "On Aphasia," New York, 1867. 
 
250 DEFECTS OF SPEECH IN IDIOCY. 
 
 ugliness of feature and awkwardness, they may puzzle 
 the most experienced.* 
 
 A case of idiocy with congenital aphasia is reported 
 by Dr. Shaw, of Haydock Lodge Asylum. The patient, 
 who had never been known to utter any articulate sound, 
 died at the age of twelve ; and at the autopsy, besides 
 other lesions, it was found that the posterior half of the 
 second frontal and the greater part of the third frontal 
 convolutions of the left hemisphere were destroyed by 
 an enormous cyst containing fluid. 
 
 It is to be desired that those having: charge of idiot 
 asylums should seek opportunities of ascertaining by 
 post-mortem examinations whether there be any con- 
 genital absence or atrophic condition of the particular 
 cortical areas that are supposed to preside over the 
 various bodily functions. 
 
 It has been said that intemperance in one or both 
 parents, about the time of conception, may cause idiocy 
 in their offspring;! if this be so, it is not unlikely that 
 any morbid cerebral condition of the parents at the 
 period of conception may give rise to aphasia in their 
 children. A case confirmatory of this view has fallen 
 
 * "A Manual for the Classification, Training, and Education of the 
 Idiot," p. 3. These writers, in describing the peculiarities of Idiocy, 
 observe that "the voice is always more or less defective, and that perfect 
 dumbness, ability to howl, cry, scream, and to sing without articulation, 
 are commonly noticed. The voice is parrot-like in most instances, that is 
 to say, the sounds bear no reference to a mental effort. Talking is rarely 
 commenced by the idiot of any class ; he must be spoken to, as a rule." 
 
 t The relation of alcoholic excesses in parents to the development of 
 idiocy in their children, has been fully considered by me in my essay 
 entitled, "The Idiot, and his Place in Creation." As this association is 
 only indirectly connected with my present subject, I cannot dwell upon it 
 here at any length. 
 
DEFECTS OF SPEECH IN IDIOCY. 25 1 
 
 under my own observation, the subject of it being a 
 remarkably fine handsome boy, five years of age, but in 
 whom the faculty of speech could not be roused into 
 action, although he had been submitted to long and 
 special training. Having noticed that he had a well- 
 formed head, that there was no hereditary predisposition 
 to cerebral disease, and that his brothers and sister were 
 by no means backward children, I was induced to push 
 my inquiries very closely in reference to the question of 
 cause ; and I then elicited from the father that about ten 
 months previous to the birth of this child, he had been 
 thrown from his horse upon his forehead, that he was 
 stunned by the fall, and that he felt confused in the head 
 for some weeks afterwards. Without wishing to draw 
 any positive conclusion from this case, it seems to me 
 that I am not exceeding the bounds of legitimate 
 inference, in connecting the shock to the nervous system 
 of the father with the congenital defect in the son. 
 
 In reference to this subject, Dr. Gairdner has observed 
 that the aphasic, supposing the disease congenital, could 
 not possibly be educated, but must remain almost an 
 idiot — the mind of an infant enclosed in the shell of a 
 man ; he further remarks that in certain forms of 
 cretinism, or of congenital idiocy, the primary defect 
 may have been aphasia, and thus the development of the 
 mental faculties an impossibility* 
 
 Dr. Bastian, in a chapter on Disorders of Intellectual 
 Expression by Speech, says that there are cases allied to 
 congenital idiocy in which, owing to some intra-cranial 
 lesion occurring either before, during, or soon after birth, 
 the child's mental condition is greatly degraded, as well 
 
 * Gairdner. " On the Function of Articulate Speech," p. 32. 
 
252 THE ETIOLOGY OF APHASIA. 
 
 as his motor power. In some of the less severe examples 
 of this type, speech is merely deferred — perhaps till the 
 fourth, fifth, or even the sixth year — and may after a 
 time become established in a natural manner.* 
 
 A case came under my own personal observation some 
 years ago of this tardy development of the faculty of 
 speech. The child never spoke at all till he was six 
 years old, and it was thought he would remain dumb. 
 At six years of age he began to talk, and was able to 
 receive an education suitable to his condition in life, but 
 he grew up to manhood a person of feeble intellectual 
 and also of feeble physical power. 
 
 3. — Aphasia has frequently been observed as a symp- 
 tom of exostosis, or of malformation of the bones of the 
 cranium :f of sanguineous deposits in the brain : of throm- 
 bosis or spontaneous deposit of fibrine in the minute 
 arteries of the convolutions — in this case the loss of 
 speech is often only temporary, the influence of the 
 collateral circulation being sufficient to counteract the 
 effects of the circulatory disturbance. M. Proust cites 
 the case of a lady with atheromatous arteries, who, at 
 irregular intervals had aphasia more or less complete, 
 accompanied by tingling and paresis of the right limbs. 
 M. Proust attributes these symptoms to minute throm- 
 boses in the diseased cerebral arteries, which disappeared 
 as soon as the collateral circulation was established :J 
 
 * Bastian. "Paralyses Cerebral, Bulbar, and Spinal," p. 99. 
 
 + Dr. Magnan, at the Biological Society of Paris, described a case of 
 aphasia, with right hemiplegia, in which the post-mortem examination 
 disclosed osteitis of the left parietal bone, which was supposed to be 
 syphilitic. The site of the diseased portions of the bone corresponded with 
 that of the ascending portion of the third frontal convolution. 
 
 J " De l'Aphasie par Adrien Proust," p. 46. 
 
THE ETIOLOGY OF APHASIA. 253 
 
 of ischaemic softening consequent on sudden embolic 
 plugging- of the arterial channels which convey the blood 
 supply, by which the functional activity of the part is 
 temporarily or permanently suspended, and the nutrition 
 of the cerebral cells arrested — of all the organic diseases 
 of the brain this is perhaps the most common cause of 
 aphasia: of tumours in different parts of the encephalon, 
 although, from the observations of Ladame, Krishaber, 
 and others, they are not a very frequent cause of 
 speech disturbance, possibly from the fact that by 
 their slow development they merely compress and dis- 
 place the nervous structures without destroying them. 
 In the " Rivista Sperimentale di Freniatria" for 1883, 
 Tamburini and Marchi have reported a case of aphasia 
 and right hemiplegia caused by a glioma involving the 
 frontal convolutions of the left hemisphere.* Loss of 
 speech may also occur as a symptom of encephalitis, 
 abscess, tubercles, hydatids yf and, in fact, of organic 
 lesions of various kinds affecting the cerebral substance, 
 especially the anterior lobes. 
 
 At the moment of writing this section my attention 
 has been called to the remarkable essay on the Surgery 
 of the Brain and Spinal Cord, read by Dr. Macewen at 
 the recent meeting of the British Medical Association at 
 Glasg-ow. In this valuable contribution to our know- 
 
 * " Contribute) alio studio delle Localizzazioni Cerebrali e dei Gliomi 
 Cerebrali." This case, which is reported in minute detail, both as to its 
 clinical history and the histological characters of the tumour, formed the 
 subject of a most elaborate article on cerebral localisation by Tamburini 
 and Marchi. 
 
 + Dr. Yellowly has reported a case of hydatid in the right hemisphere, 
 with left hemiplegia and impairment of speech. — " Medico-Chirurgical 
 Transactions," vol. ii., p. 262. 
 
254 MACEWEN ON THE SURGERY OF THE BRAIN. 
 
 ledge of cerebral disease, the author mentions a case of 
 abscess of the brain, the clinical history of which may 
 truly be said to be unique in the annals of Brain Surgery. 
 
 A cicatrix on the forehead marked the site of an 
 injury, under which the skull was bare ; had this cicatrix 
 been taken as a guide to the localisation of the abscess, 
 and an operation had been performed there, no abscess 
 would have been found ; but other phenomena were 
 exhibited, which enabled its seat to be definitely recog- 
 nised. A convulsion, accompanied by loss of conscious- 
 ness, commenced on the right side, and gradually 
 involved the whole body ; on its cessation, absolute 
 hemiplegia of the right side was present, and remained 
 for two hours, during which time the patient was aphasic. 
 Both these phenomena became much less marked at the 
 end of this period ; from these symptoms the abscess 
 was diagnosed to be situated in the immediate vicinity 
 of Broca's lobe. 
 
 Trusting to these localising symptoms, it was proposed 
 to open the abscess aseptically by exposing Broca's lobe. 
 Unfortunately, the result of a consultation was decidedly 
 to negative this proposal. The parents then refused 
 consent, notwithstanding the assumption by Dr. Mac- 
 ewen of the sole responsibility of advising and perform- 
 ing the operation. Thirty-six hours afterwards the 
 convulsions returned, and persisted until a fatal issue 
 ensued. 
 
 After death the friends acquiesced in the proposal to 
 have the operation performed, just as it would have been, 
 had permission to do so been granted during life. The 
 skull was trephined, the brain exposed, and an instru- 
 ment was introduced through the third frontal convolu- 
 tion for half an inch, when pus flowed through the 
 
MACEWEN ON THE SURGERY OF THE BRAIN. 255 
 
 incision, proving the accuracy of the diagnosis, and 
 giving poignancy to the regret that the operation had 
 not been performed during life. The abscess, about the 
 size of a pigeon's egg, was situated in the white matter 
 of the basis of the second and third frontal convolutions. 
 
 In commenting upon the above unique case, Dr. 
 Macewen says that the precise spot which the abscess 
 occupied was accurately determined from the localising 
 phenomena induced by the focal lesion, which were 
 trusted as indicating its position, though pointing to a 
 different part of the brain from that which would have 
 been selected had the seat of injury been accepted as a 
 guide. The operation showed how easily the pus could 
 have been evacuated, though the unfortunate refusal to 
 allow it to take place during life, leaves uncertain the 
 ultimate issue, but, judging from subsequent experience, 
 worse cases have recovered after operation.* 
 
 It would seem that disease in the neighbourhood of 
 the anterior lobes, but sufficiently near to exercise 
 indirect pressure upon them, may give rise to aphasia. 
 Dr. A. Voisin has recorded a case where it was caused 
 by the pressure exercised on the left anterior lobe by a 
 considerable hemorrhagic clot in the temporo-sphenoidal 
 lobe on the same side.-J- 
 
 Dr. Oedmansson, of Stockholm, mentions a case of 
 tubercles in the brain, in which aphasia was a symptom 
 during life ; after death there was found haemorrhage 
 into the left insula.J 
 
 * British Medical Journal, August nth, 1888, p. 303. 
 
 t " Nouveau Dictionnaire de Medecine et de Chirurgie Pratique, Article 
 Aphasie." 
 
 % Dublin Quarterly Journal, Nov., 1868. Translated from the Hygiea, 
 by Dr. W. D. Moore. This is a short review of the aphasie question by a 
 
 R 
 
256 HUGUENIN ON MENINGITIS TUBERCULOSA. 
 
 Huguenin, in his article on meningitis tuberculosa, 
 says that some cases begin with aphasia, which are 
 highly interesting on various grounds. He illustrates 
 his remarks by several cases given in detail, from which 
 I have selected the following, which he quotes from 
 Traube : — 
 
 Man, thirty-four years old ; hereditary predisposition to phthisis ; 
 the affection of the brain begins with chills ; severe headache ; the 
 pupils, and, generally, the motility normal at the beginning. 
 
 December 8th. — Restlessness ; congestive redness on the head ; 
 in the evening, suddenly ; aphasia ; incorrect naming of objects; 
 great restlessness and excitement caused by this ; consciousness 
 entirely clear. 
 
 December 9th. — Speech quite unintelligible ; restlessness ; slight 
 signs of right facial paralysis ; convulsive movements in the ex- 
 tremities. 
 
 December 10th. — Somnolence; aphasia still exists; attack of 
 convulsions. The rest of the course of the disease was remarkable 
 for its severe convulsions. 
 
 Autopsy. — Old tuberculosis of the lungs; spleen, kidneys, liver, 
 show miliary tubercles ; pia mater much thickened in the convexity, 
 still more so at the base, especially at the chiasma, and most of all 
 in the left fissure of Sylvius ; abundance of small miliary knots ; 
 hydrocephalus ; choroid plexus showing tubercles. 
 
 In all the observations quoted by Huguenin the 
 aphasia was sudden, and he says that a suddenly occur- 
 ing aphasic lesion may be used to diagnosticate miliary 
 tuberculosis of the pia mater, and he further adds that 
 in all cases of aphasia we must think of tuberculous 
 meningitis as one possible cause.* 
 
 Swedish physician, together with some original cases of great interest; the 
 author, however, seems but imperfectly acquainted with the contributions 
 of British authors. 
 
 * Huguenin. " Acute and Chronic Inflammations of the Brain and its 
 Membranes." Ziemssen's Cyclopedia, Vol. xii., p. 543. 
 
GOWERS ON IRRITATIVE INHIBITION. 257 
 
 Gowers, in speaking of loss of speech in certain cases 
 of tuberculous meningitis, says that it is probably a con- 
 sequence of irritative inhibition, and he adds that the 
 speech centre seems specially susceptible of inhibition.* 
 
 Instances of loss or impairment of speech dependent 
 upon most of the causes mentioned in this section, have 
 been recorded in the previous pages of this work. 
 
 4. — It may occur as a consequence of direct injury to 
 the brain ; of this cause several instances have been 
 given in the preceding pages (Lesur, Castagnon, Rom- 
 berg, Bergmann, Kolk, H. Jackson). Traumatic cases 
 may be regarded as veritable vivisections, and their study 
 is invaluable in an etiological point of view, as con- 
 tributing, perhaps more than any other class of cases, to 
 sound ideas as to the question of the cerebral localisation 
 of our divers faculties. 
 
 Napoleon's great surgeon, Baron Dominic J. Larrey, 
 in his Clinique Chirurgicale, has carefully recorded 
 several cases of traumatic lesion of the brain, from which 
 he has drawn conclusions which are to a great extent 
 confirmatory of our modern theories of localisation. 
 One of the most interesting of this collection is the 
 following : — 
 
 On November 12th, 1821, a man named Blanc received a thrust 
 from a fencing foil, the button of which had become detached, the 
 unprotected end of the foil striking him behind the external angular 
 process of the left side of the cranium. He immediately fell down, 
 and on getting up, it was found that he was deprived of speech, 
 sight, and hearing, there being at the same time some signs of 
 mental aberration. Considerable benefit ensued from bleeding, but 
 a few days afterwards there was a relapse, and it was noticed that 
 
 * "Diseases of the Nervous System," Vol. ii., p. 115. 
 
258 ON TRAUMATIC APHASIA, OR LOSS OF 
 
 the patient no longer pronounced substantives or proper names. 
 It was not the recollection of this class of words that he had lost, 
 but the power of articulating them ; for if he was asked his name, 
 he would show his bed-ticket, and point to his name inscribed upon 
 it. Not being able to mention an object by name, he would 
 employ a paraphrase having a more or less intimate relation to the 
 object that he wished to describe. Eventually the above defect 
 became intermittent, and ultimately completely disappeared under 
 the use of moxas.* 
 
 The following curious case, quoted by Dr. Popham, of 
 Cork, is not only interesting from its traumatic cause, 
 but from the local morbid condition which coincided 
 with recovery : — 
 
 A boy, aged 15, received a kick from a cow, between 
 the nose and the forehead, which stunned him, but 
 left apparently at the time, no other injury than a few 
 scratches and slight epistaxis, so that he walked after it 
 some miles to a fair. On the fourth day he was seized 
 whilst at work with vertigo and loss of speech, his 
 hearing, taste, and sight, as well as deglutition, remain- 
 ing unaffected. A variety of remedies, amongst others 
 
 * Since the publication of my first edition, my attention has been called 
 by an eminent Parisian military surgeon to an interesting monograph on 
 Traumatic Dysphasia, by Dr. A. Martin. It contains a succinct account of 
 the elder Larrey's extensive experience of the psychical results of gun-shot 
 wounds of the brain, and is well worthy of the careful perusal of those 
 interested in this field of research. M. Martin's treatise also contains the 
 surgical experience of Larrey's son, M. le Baron Hippolyte Larrey, Membre 
 de L'Institut, to whom I am much indebted for great personal courtesy to 
 myself. 
 
 From a careful study of the clinical facts furnished by the vast experience 
 in military surgery of the two Larreys, father and son, M. Martin arrives at 
 the conclusion that traumatic aphasia is a very frequent, if not a constant, 
 result of wounds of the antero-lateral portion of the left side of the head, 
 whilst it is only very exceptionally observed in connection with lesions of 
 the right anterior lobe. 
 
SPEECH FROM DIRECT INJURY TO THE BRAIN. 259 
 
 mesmerism, were tried, but without any benefit. He 
 continued for twelve months as servant to a medical 
 man, although totally mute, when he got extensive 
 inflammation of the anterior part of the scalp followed 
 by suppuration, and regained his speech as suddenly as 
 he had lost it eighteen or nineteen months before.* 
 
 Dr. Th. Simon, of Hamburg, in an elaborate essay on 
 the theory of aphasia, has recorded a typical case, illus- 
 trative of the cause of the loss of the faculty of articulate 
 language. 
 
 A perfectly healthy man, twenty-three years of age, fell from his 
 horse when riding with several companions, one of whom was a 
 physician. He got up immediately, seized the bridle, and was 
 about to re-mount, when his medical companion approached, and, 
 after examination, discovered a small wound on the left side of the 
 head, with depression of the bone. He was totally unable to speak, 
 but could make himself perfectly understood by signs. There was 
 no motor paralysis of any kind. 
 
 On his being removed to his own house, a more minute exami- 
 nation was made, and the precise nature of the accident was 
 ascertained. In the left parietal region, a little above the planum 
 semicirculare, was a wound of the size of a two groschen piece 
 (Zweigroschenstiick), in the bottom of which could be felt a piece 
 of depressed bone. 
 
 Omitting the daily progress of the case, it is sufficient to say that 
 death ensued at the end of three weeks from purulent meningitis 
 and inflammatory softening. 
 
 Autopsy. — The post-mortem appearances are given in great 
 detail. In the left parietal region there was found a round hole 
 three-quarters of an inch in circumference, as if made by a bullet ; 
 at the bottom of this hole was found a piece of detached bone 
 denuded of periosteum, from the inner table of which a spiculum 
 had become separated and was embedded in the third frontal con- 
 volution, which, as also the adjacent portions of the second and of 
 the island of Reil, were softened. 
 
 * Popham op. cit., p. 9. 
 
260 ON OPERATIVE INTERFERENCE IN APHASIA. 
 
 It is impossible to exaggerate the scientific importance 
 of this carefully detailed observation. It was evidently 
 considered by Simon as an experimentum cruris, for in 
 commenting upon the inference to be deduced from it, 
 he says that the fact of a traumatic lesion of the third 
 left frontal convolution in a previously perfectly healthy 
 man, resulting in complete aphasia, compels him to 
 range himself with those who would localise aphasia in 
 that particular fold of the brain. * 
 
 There is one point in the treatment of this patient 
 that I must venture to criticise. Simon tells us that 
 the question of trephining was raised, and that after 
 consultation, the proposition was negatived. This de- 
 cision is scarcely in accordance with our modern ideas 
 of Brain Surgery, and I must think that the operators 
 of the present day would not have allowed this man to 
 die without attempting some surgical means for his 
 relief. Of course, it must be admitted that at the time 
 this patient was under observation, the profession was 
 scarcely in a position to judge adequately of the value 
 of operative interference ; recent experiments, however, 
 in Brain Surgery, especially those of Macewen, Godlee, 
 and Horsley, have placed this question beyond dispute, 
 and the earlier trephining is performed in such cases, the 
 greater the chance of ultimate success. 
 
 The annals of medical literature of the last quarter of 
 a century abound with cases of traumatic aphasia, from 
 which I select the following : — 
 
 A farmer, in a dispute with his brother-in-law, was knocked 
 down by a blow on the head with an iron bar ; he immediately got 
 
 * Casuistische Beitrage zur Lehre von der Aphasie, von Dr. Th. Simon 
 Berliner klmische Wochenschrift, 1871, s. 599. 
 
ON TRAUMATIC APHASIA. 26 1 
 
 up, complaining bitterly of the gross assault of which he had been 
 the victim. He was able to walk home, and for some time was 
 able to articulate distinctly several words ; he was soon, however, 
 entirely deprived of the power of speech, and some slight right 
 hemiplegia manifested itself. Behind the left fronto-parietal suture 
 could just be distinguished a slight superficial contused wound, one 
 or two centimetres in length, and quite superficial. 
 
 Although unable to speak, he understood all that was said to 
 him ; he put out his tongue when asked, and looked straight at the 
 person who addressed him. He seemed progressing fairly well till 
 the third day, when symptoms of secondary inflammation set in, 
 and he died on the fourth day after the receipt of the injury. 
 
 A medico-legal autopsy was made, when the following morbid 
 condition was disclosed. Slight infiltration of blood beneath the 
 contused wound; fracture of the anterior and inferior portion of the 
 left parietal bone, extending to the posterior border of the frontal 
 and to the great wing of the sphenoid ; between the dura mater 
 and the bone was a clot of blood, caused by a rupture of a branch 
 of the middle meningeal artery, which, from its position, pressed 
 upon the anterior lobe of the brain at the point corresponding to 
 the third left frontal convolution.* 
 
 Professor Ball has recorded the case of a merchant who went to 
 reside in a town in Central America. He there took into his ser- 
 vice a negress of gigantic stature, herculean strength, and of a very 
 violent temper. One day, having occasion to remonstrate with 
 her, she gave him a severe blow on the head with her fist. He fell 
 down unconscious, and, on reviving, he was completely aphasic, 
 but not paralysed. The aphasia was of short duration, but he fell 
 into a state of intellectual torpor, f 
 
 I could multiply ad infinitum the record of cases of 
 loss of speech as the result of direct injury to the brain, 
 but I will only mention three cases of traumatic aphasia 
 that have fallen under my own observation. 
 
 Malichecq. " Gazette des Hopitaux," 1865, p 322. 
 t " L' Encephale," No. 3, 1881, p. 374. 
 
262 ON TRAUMATIC APHASIA. 
 
 In November, 1882, I was requested by Dr. Mills, the police 
 surgeon of Norwich, to see with him a man, aged 36, who had been 
 struck on the head with a brush just above the left ear. When 
 seen by Dr. Mills a few hours afterwards, he found a bruise about 
 two inches above the left ear, and of the size and shape of a hen's 
 egg; the right arm and leg were paralysed, also the organs of 
 speech. His intelligence was clear, but he was unable to say more 
 than " Yes " or " No," and one or two other single words, such as 
 "ear" and "wife." At my visit nine days after the accident, I 
 found complete paralysis of the right arm, but he could move the 
 leg tolerably well in bed ; there was still aphasia, as he could not 
 make himself understood, being only able to say a few isolated 
 words. 
 
 The second case I had an opportunity of seeing in the Norfolk 
 and Norwich Hospital, under the care of my surgical colleague, 
 Mr. Crosse. The subject of it was a young lady, aged 31, who was 
 knocked down by an empty box which struck her forcibly on the 
 left temple, the accident having been caused by a horse running 
 away with a cart ; the vehicle coming in contact with some obstacle 
 in the street, the box fell out and struck Miss N., as above stated, 
 on the left side of the head, knocking her down, and causing the 
 right side of the head to come in contact with the curb-stone ; she 
 was taken to the hospital in a state of complete unconsciousness. 
 
 On examination a large bruise was observed over the left temple, 
 and some swelling of the left eyelid ; the surface was cold, pulse 
 feeble, pupils normal, some blood oozing from a wound at the 
 back of the right ear, but none from either meatus ; there was no 
 evidence of motor-paralysis, or of any injury to limbs. 
 
 This patient remained quite unconscious for eight days, when 
 she sat up in bed and looked about her, but did not speak. With- 
 out going into daily details, I will merely add that at the end of 
 the second week, some loss of motor power on the right side began 
 to manifest itself; she slowly and gradually regained her speech, 
 but on her recovery, it was noticed that she had entirely lost all 
 remembrance of events immediately preceding the accident, being 
 quite unable to recall what she did on the morning when it 
 occurred, or even where she had been on that day.* 
 
 * Dr. Bell, of Edinburgh, has published a number of cases of severe 
 concussion and cranial injury, in which the patients had no recollection of 
 
ON TRAUMATIC APHASIA. 263 
 
 The third case was that of a man admitted into the Norfolk and 
 Norwich Hospital under the care of my colleague, Mr. Williams, 
 who, knowing the interest I took in such cases, kindly asked me to 
 see the patient, who was a gardener, aged 30, who, in a quarrel, was 
 struck with the crome of a walking-stick over the left temple. He 
 was knocked down by the blow, but was able to get up immediately, 
 when he found he was unable to speak. There was no motor 
 paralysis of any kind ; in fact he walked home, a distance of half a 
 mile, and actually helped a friend to yoke a horse to a cart that 
 was to convey him to the hospital ; for, although speechless, he 
 intimated by signs his wish to be taken to that institution. 
 
 On being conveyed to the hospital, he walked into the ward, was 
 quite unable to speak, but intimated by signs that he did not wish 
 to be undressed. On examination, a distinct indentation admitting 
 the tip of the finger was observed about an inch and threequarters 
 above the left ear. For a period of eight hours he was quite 
 speechless, but at the end of that time he began to say a word or 
 two, and after a few days the aphasia passed off. 
 
 It will be observed that in all the three above-mentioned 
 cases, the loss of speech was caused by direct violence 
 applied to the left temple ; in fact, to that part of the 
 cranium corresponding to the supposed centre for speech ; 
 but in Mr. Crosse's case, there was such prolonged 
 intellectual torpor, that it may be assimilated to that of 
 M. Ball, which I have quoted in this section, and which 
 the learned French professor characterised as one of 
 cerebral torpor. 
 
 the events which happened within a limited space of time immediately 
 before the accident ; this loss of a small section of memory coinciding with 
 perfect power of recollecting all more distant facts, and with unimpaired 
 memory and mental power after recovery. Amongst others, he mentioned 
 the case of a miner suffering from severe cranial fracture, who utterly 
 forgot the Saturday and Sunday preceding the morning of the accident. 
 This curious lacuna in the memory of events has an analogy to the cases 
 where a similar defect exists in the power of recalling any particular 
 language. 
 
264 THE ETIOLOGY OF APHASIA. 
 
 The annals of military surgery are rich in instances of 
 traumatic aphasia, the result of gunshot wounds of the 
 head, but the impairment of language is only mentioned 
 as it were en passant ; now, however, that the attention 
 of the profession is being called to the localisation of the 
 cerebral faculties, it is to be hoped that a more detailed 
 account of the psychological phenomena attendant on 
 gunshot wounds of the head will in future be given, and 
 that " Surgery Militant" will thus make its vast resources 
 more available for the settlement of complex and obscure 
 questions in cerebral pathology. 
 
 5. — It may occur as a remote symptom of endoperi- 
 carditis, where fibrinous vegetations detached from the 
 cardiac valves have been carried into the cerebral 
 arteries (usually the middle cerebral)* and have thus 
 caused embolism ; thus establishing a relationship be- 
 tween cardiac disease, obliteration of the middle cerebral 
 artery, softening of the brain from loss of nutrition, and 
 aphasia. As illustrating the above sequence of symp- 
 toms, I would refer to the history of William Lemon 
 among my own observations, and to the cases of M. 
 Peter and Dr. Scoresby Jackson, also mentioned in the 
 preceding pages. 
 
 The coincidence of cardiac disease with aphasia is 
 most common; it will be remembered that of the thirty- 
 four cases recorded by Dr. Hughlings Jackson in the 
 London Hospital Reports, the heart was more or less 
 affected in twenty instances. 
 
 Dr. Cesare Lombroso, of Pavia, in commenting upon 
 the cases of Dr. Jackson, denies the construction usually 
 
 * We may assume that these vegetations are more likely to pass up the 
 left carotid. 
 
INFLUENCE OF THE SYMPATHETIC SYSTEM. 265 
 
 placed on the coincidence of aphasia and disease of the 
 heart and large arteries ; according to him, the disease 
 in the nervous centres would be the cause rather than the 
 consequence of the affection of the heart and arteries, the 
 disease in these last depending upon perverted organic 
 nutrition, the result of faulty innervation. Dr. Lombroso 
 further remarks that although there may be cases in 
 which cardiac hypertrophy may determine disorders of 
 the nervous centres, yet, as a rule, these lesions in the 
 circulating organs are secondary and not primary.* 
 Although the high scientific position of the distinguished 
 Italian professor naturally claims for any statement of 
 his the greatest possible respect, I apprehend that his 
 views of the sequence of heart and head affections will 
 not be unreservedly adopted by English pathologists. 
 
 Impairment of speech may also be caused by various 
 disturbances of the cerebral circulation, including con- 
 gestion from general plethora, increased cardiac action, 
 venous obstruction, or vaso-motor paralysis of the cere- 
 bral vessels. Here I would observe that the role of the 
 sympathetic system in the causation of speech distur- 
 bance has not been sufficiently estimated, although from 
 the valuable researches of Claude Bernard, Brown- 
 Sequard, Schiff, and others, we can no longer doubt of 
 its functional importance ; in fact, the brilliant experi- 
 ments of these physiologists have thrown a flood of light 
 on the diagnosis of cerebral diseases, the pathogeny of 
 which had hitherto been wrapped in obscurity. 
 
 Disorders of the ganglionic system of nerves, by 
 inducing local vascular hypersthenia or hyposthenia, may 
 give rise to hyperemia or anaemia, of which conditions 
 aphasia may be the result. 
 
 * " Studi Clinici sulle Malattie Mentali," p. 9. 
 
266 THE ETIOLOGY OF APHASIA. 
 
 6. — It has been observed as a symptom of disease of 
 the spinal cord (Maty, Abercrombie, &c.) ; Velpeau, in 
 the "Revue Medicale " for 1826, has recorded a case of 
 left hemiplegia with aphasia, where after death he found 
 in the centre of the right column of the spinal cord, and 
 in the middle of the cervical portion, a cavity three 
 inches long and two or three lines in diameter, full of 
 soft matter like pus ; in the left column of the same 
 portion of the cord, there was a similar disease, but to a 
 less extent; the brain was healthy.* 
 
 As I am treating of Disturbances of Speech in general, 
 those connected with spinal disorders must form the 
 subject of brief allusion, although it is clear there is no 
 psychical or intellectual factor in their production, and 
 they may be considered as simply affections of articula- 
 tion (anarthria). 
 
 7- — Aphasia may be due to functional disturbance of 
 the brain as well as to organic disease of that organ, and 
 may appear as a symptom of various purely functional 
 disorders ; in fact, whatever interrupts the processes of 
 ideation and thought, such as fright, alarm, or emotional 
 shocks, may cause inability to speak. It may ensue as 
 a nervous symptom ; thus many persons under the 
 influence of anger, joy, or excitement of any kind, are 
 seized with a temporary incapacity to speak. 
 
 Instances of suspension of the power of utterance from 
 great mental emotion, are of daily occurrence, and the 
 great writers of antiquity, who seem to have been such 
 close observers of nature, have not failed to show their 
 knowledge of the psychological results of any sudden 
 
 * Abercrombie. " Diseases of the Brain and the Spinal Cord," p. 357. 
 
INFLUENCE OF NERVOUS EXCITEMENT. 267 
 
 and unexpected shock upon the nervous system. Every- 
 body is familiar with the lines of Virgil in which he 
 makes ^Eneas describe the psychical effect produced 
 upon him by the appearance. of the ghost of Creusa : — 
 
 " Obsiupui, steteruntque coma ; vox faucibus hcesit." 
 
 Dr. Todd, under the head of emotional paralysis, men- 
 tions the case of a man between fifty and sixty years of 
 age, of an irritable temperament and hypochondriacal 
 habits, whp, in a very animated conversation, became 
 excited to such a degree that his power of speech com- 
 pletely abandoned him ; there was no paralysis, and the 
 mental faculties were unaffected ; he continued speech- 
 less, however, for about a week, and in a short time the 
 power of speech fully returned.* Mr. Dunn mentions an 
 instance of aphasia occurring during the latter months of 
 pregnancy, after a sudden and painful shock.f 
 
 In the report on military prisons by Captain Du Cane, 
 it is stated that a prisoner being checked at drill by one 
 of the warders, said he wished " that God Almighty 
 would strike the warder dumb;" whereupon the prisoner 
 himself was struck dumb on the spot, and did not recover 
 his speech for seven days. % 
 
 Dr. Panthel, of Limburg, has furnished the following 
 curious illustration of the effect of nervous excitement 
 upon the power of speech : — 
 
 A peasant boy, twelve years of age, previously in good health, 
 was very much affected at the grave of his father, whom he had 
 unexpectedly lost. During the interment he threw himself down, 
 and was carried home unconscious. The fainting lasted about a 
 
 * "Clinical Lectures on Diseases of the Brain," p. 278. 
 f " Medical Psychology," p. 77. 
 % Medical Times, Oct. 23rd, 1869. 
 
268 ON EMOTIONAL APHASIA. 
 
 quarter of an hour, when he awoke in the undisturbed possession 
 of all his faculties, sensory and motor, except that he was unable to 
 produce any sound. Dr. Panthel having been summoned, noticed 
 that the intellect was unaffected, that he suffered no pain or 
 uneasiness — as indicated by the motion of the head — but that he 
 had lost his speech and voice, and could utter no sound whatever. 
 Pie could move the tongue and lips in all possible directions, and 
 the functions of deglutition and respiration were unaffected. On 
 being questioned and urged to speak, he seemed confused, and by 
 a shake of the head expressed his inability. If he attempted to 
 speak, violent spasms were produced in the muscles of the larynx, 
 governed by the hypoglossal nerve — the sterno-thyroid, hyo-thyroid, 
 and sterno-hyoid. On Dr. Panthel's compressing these parts with 
 the hand, the cramp immediately ceased, and in answer to the 
 question whether he could speak, he instantly replied, with cheerful 
 countenance, " Yes, speech is my greatest delight ! " When the 
 pressure was removed, the inability to speak recurred ; the power 
 of utterance being instantly restored by again applying the hand to 
 the supra-laryngeal region.' This singular condition lasted three 
 days, when he was again in undisturbed possession of speech. A 
 fortnight afterwards, being in a field, a brace of partridges suddenly 
 flew past him, when the speech defect above described returned for 
 two days. A week later, in consequence of some strong mental 
 emotion, another relapse ensued, which lasted only a few hours. 
 After this no fresh attack occurred, and the lad continued perfectly 
 healthy.* 
 
 Mr. de Berdt Hovell, who considers this class of case 
 as the result of nerve shock, has proposed the word 
 Neurokinesis as a suitable term to express the condition 
 of the nervous system which ensues upon shock, either 
 physical or moral, and in an interesting essay on 
 Emotional Aphasia he has recorded the following typical 
 illustration of his views : — 
 
 I was called at midnight to see a lad, aged sixteen, who had lost 
 the power of speech. He was rather excited, pulse quick, &c, but 
 
 * "Deutsche Klinik." Jahrgang, 1855. S. 451. 
 
APHASIA ASSOCIATED WITH EPILEPSY. 269 
 
 had no other presentable symptom other than that, like Zachariah, 
 "he was dumb and unable to speak," and made signs that he 
 wanted writing material, by means of which he expressed himself 
 correctly, and gave pertinent answers to questions asked. He 
 recovered his speech in twenty-four hours, and rested for a week ; 
 but, notwithstanding caution and advice not to over-exert himself, 
 the same condition of aphasia returned about six weeks after, and 
 continued forty-eight hours, when he again recovered, and was 
 apparently well. About two months afterwards a third attack 
 occurred, apparently from excitement on seeing a boat-race, in 
 which, being much interested, he ran and shouted along the bank 
 for some time and distance. From this, the third attack, he did 
 not recover so readily, and, in accordance with the wishes of his 
 friends, I procured his admission into an hospital, where he under- 
 went various examinations, but after the lapse of five days he 
 recovered his speech under the influence of galvanism. 
 
 Under this head may be classed the disturbances of 
 speech so common in chorea ; here, of course, the defect 
 is not psychical, but the result of choreic disturbance of 
 the functions of the muscles of articulation. 
 
 8. — The epileptic condition seems to be a frequent 
 cause of aphasia. Leborgne, Broca's patient, was an 
 epileptic, as were also the subjects of several of the cases 
 I have recorded, and the term epileptic aphemia has been 
 applied to them. M. Delasiauve has recorded the case 
 of an epileptic woman, in whom aphasia alternated with 
 epilepsy — thus, she would be aphasic for a week, when, 
 on the occurrence of a fit of epilepsy, the power of speech 
 would return, paralysis of the bladder, however, ensuing; 
 by and by she would again lose her speech, and the 
 same sequence of symptoms would ensue. 
 
 A curious instance of the coincidence of aphasia with 
 epilepsy is recorded by Dr. Oedmansson, where the epi- 
 lepsy occurred after a blow on the vertex ; the aphasia 
 
270 ETIOLOGY OF APHASIA. 
 
 was transient, but frequent ; on every occasion that 
 several attacks occurred soon after one another, the 
 power of speech suffered in a greater or less degree, and 
 was gradually completely lost. When the attacks ceased 
 or became less frequent, the power of expression soon 
 returned ; at the same time, both intellectual distur- 
 bances and occasionally also paralytic phenomena set in 
 and disappeared, but the aphasia always preceded them, 
 and was the last to cease.* 
 
 9. — Loss of speech has frequently been observed 
 associated with neuralgia. At the meeting of the 
 Societe Medicale des Hopitaux, at Paris, April 12th, 
 1867, three cases of loss of speech were mentioned as a 
 symptom or accompaniment of facial neuralgia. The sub- 
 ject of one of them (that mentioned by M. Guyot), was a 
 lady aged thirty-four, who for fourteen years had suffered 
 from facial neuralgia, and who was suddenly seized with 
 aphasia, which lasted half an hour and then ceased ; the 
 loss of speech recurred under similar circumstances, when 
 both it and the neuralgia were removed by sulphate of 
 quinine. 
 
 10. — Reflex action. Dr. Brown-Sequard, in his course 
 of lectures delivered before the New York Academy of 
 Medicine, expressed the opinion that aphasia was a 
 reflex phenomenon, and that he had seen cases due to 
 peripheral irritation, and in which no brain lesion could 
 be discovered after death. 
 
 Sauvages, under the name of Mutitas Verminosa, 
 mentions the case of a child in whom loss of speech was 
 
 * Oedmansson, op. cit., p. 493. 
 
ETIOLOGY OF APHASIA. 27 1 
 
 due to the presence of worms ; anthelmintics having 
 been administered, thirty-six lumbrici were expelled, 
 when speech was restored, with the exception of a diffi- 
 culty in pronouncing the letter B.* 
 
 Hoffmann also mentions a similar case, where the 
 cerebral irritation from reflex action was more permanent 
 and accompanied by opisthotonos. The occurrence of 
 the aphasia was sudden, but although the administration 
 of anthelmintics soon resulted in the expulsion of fifteen 
 worms, it was only after an appropriate treatment of 
 many weeks that the power of speech began to improve. f 
 The same author says elsewhere, that he has frequently 
 seen and cured cases of loss of speech from the presence 
 of worms. 
 
 Dr. Gibson, of Hull, has also recorded a case of 
 aphasia with complete paralysis of the extremities, 
 caused by Trichocephalus dispar, and cured in twelve 
 days by appropriate treatment. J 
 
 An American writer, Dr. Shaw, has stated that there 
 is a direct communication between difficulties of speech 
 and exaggerated tendon-reflex. Dr. Spitzka, on the 
 other hand, maintains that clinical observation does not 
 bear out Dr. Shaw's conclusions. Thus, in eight instances 
 in which the knee-jerk was exaggerated, speech was only 
 once markedly affected, whereas on two occasions in 
 which reflex was abolished, speech was much affected.^ 
 
 1 1. — Several instances are on record in which loss of 
 speech supervened on atmospheric changes, or on appli- 
 
 * " Nosologia Methodica," torn, i., p. 779. 
 f " Hoffmanni Opera," torn, iii., cap. vii., obs. iii. 
 X Lancet, Aug. 9th, 1862. 
 
 § American /ournal of Neurology and Psychology, August, 1883. 
 
 S 
 
272 ATMOSPHERIC INFLUENCES; HAMMER PALSY. 
 
 cation of cold or heat to the head. In the case I have 
 quoted from Dr. Jackson, of Pennsylvania, the aphasia 
 occurred after a check to the cutaneous perspiration from 
 exposure to the night air; Dr. Banks records an instance 
 of aphasia and deafness occurring after fatigue on a very 
 cold day ; and Abercrombie mentions a case of a young 
 man who bathed twice in the river Tweed, and who after 
 coming out the second time lay down on the bank and 
 fell asleep without his hat, exposed to the intense heat of 
 the sun. On awaking he was speechless, but walked 
 home, and seemed to be otherwise in good health.* 
 
 Many years ago an invalid soldier came under my own 
 observation, who five months previously, whilst at Corfu, 
 had a sunstroke, which caused left hemiplegia and loss of 
 speech for a week. This case is of some interest, not only 
 from the paralysis being on the left side, but also from 
 my having made a note of it long before I could have 
 had any preconceived ideas about modern localisation 
 theories. 
 
 Loss or disturbance of speech may also be caused by 
 cerebral vibration without visible lesion, by simple mole- 
 cular disturbance of the brain cell§, as exemplified in a 
 form of cerebral disturbance described by Dr. Franks- 
 Smith under the name of Hephsestic Hemiplegia, or 
 Hammer Palsy, as it occurs amongst the artisans of 
 Sheffield. In many of these observations, aphasia was a 
 prominent symptom, and the patients were exposed to 
 none of the causes of cerebral lesion with the exception 
 of the continual use of the seven-pound single-handed 
 hammer. In every instance complete or partial recovery 
 followed the use of phosphorus, iron, strychnia, and cod- 
 
 * Abercrombie, op. cit. p. 155. 
 
EFFECTS OF CERTAIN DRUGS ON SPEECH. 273 
 
 liver oil, with absolute rest and prolonged absence from 
 the forge.* 
 
 12. — Certain drugs, especially those obtained from the 
 Natural Order Atropacae, would seem in some instances 
 to suspend the power of speech. Sauvages, under the 
 head of Mutitas a narcoticis, says that certain robbers 
 which infested the neighbourhood of Montpellier, in 
 order the more successfully to exercise their profession, 
 were in the habit of drugging wine with the seeds of the 
 Datura Stramonium, the effect of which was, that those 
 who drank it could not speak for one or two days, 
 although wide awake. He also states that he has ob- 
 served the same effect from the berries of the Atropa 
 Belladonna, and from the roots of Hyoscyamus Niger. 
 This shrewd observer has not omitted to speak of that 
 want of control over speech produced by alcohol "idem 
 accidit cum temulentid imb a vini abusn balbuties orta 
 quotidie observatur."\ 
 
 In a well-marked case of poisoning by Belladonna 
 observed by Mr. Nicholas Grattan, of Cork, aphasia was 
 a prominent symptom. A lady, aged 42, drank by mis- 
 take two ounces and two drachms of Belladonna Liniment 
 (P.B.). She was treated by the subcutaneous injection 
 of one-fifth of a grain of pilocarpine every fifteen minutes ; 
 after the fourth dose speech was restored. % 
 
 Dr. Paget Blake, of Torquay, has also published a case 
 of poisoning by Stramonium (if drachm of the tincture), 
 in which the patient on recovering his speech — which he 
 had at first entirely lost — misnamed almost everything 
 
 * Lancet, March 27th, 1869, p. 427. 
 
 f " Nosologia Methodica," torn, i., p. 177. 
 
 J Lancet 1 88 1. 
 
274 LOSS OF SPEECH CAUSED BY THE EXCESSIVE 
 
 he wanted, although he was evidently quite unaware 
 that he did so ; several days elapsed ere he could men- 
 tion his wants without calling something by a wrong 
 name.* It will be observed that the aphasia, which was 
 atactic at first, before passing off assumed the amnesic 
 form. 
 
 A very curious case was read at the Leeds Medico- 
 Chirurgical Society by Dr. Ginders, of Normanton, in 
 which aphasia was attributed to the excessive use of 
 tobacco. The patient, a female aged fifty-eight, had 
 been a great smoker for fifteen years, and during the last 
 four years of that period she is said to have consumed 
 weekly six ounces of common shag tobacco, which she 
 smoked in a short black pipe ! 
 
 Dr. Popham, of Cork, has noticed the occurrence of 
 temporary dumbness in a boy who had eaten the roots 
 of " GEnanthe Crocata," which he had mistaken for field 
 carrots.f 
 
 Dr. Nichols, of Chelmsford, has seen aphasia produced 
 by the administration of Cannabis Indica ; and Dr. John 
 Ogle has recorded a case in which opium given in small 
 doses always caused the patient to be talkative, "to talk 
 foolishly," as she called things by their wrong names; 
 the peculiarity passed off when the effects of the drug 
 ceased. There was no symptom whatever of any cere- 
 bral disease, and Dr. Ogle presumes that the effect of 
 the opium was the result of some peculiar modification 
 of the cellular or vascular action within the brain. % 
 
 * St. George's Hospital Reports, 1868, p. 159, where minute details of 
 this interesting case are given. 
 
 f Dublin Quarterly Journal of Medical Science, Nov., 1865, p. 484. 
 X Lancet, Aug. 22nd, 1868. 
 
USE OF TOBACCO ; BLOOD POISONING. 275 
 
 13. — Septicaemia. Blood poisoning — whether from 
 uraemia, as in Bright's disease, or from alcoholism, gout, 
 plumbism, or syphilis — is another frequent cause, illus- 
 trations having been furnished by Andral, Jaccoud, 
 Heymann, and Auguste Voisin. The case of Anna 
 Maria Moore, reported by myself, may be considered as 
 due to blood poisoning, for a diseased action which is set 
 down as the result of the climacteric change, may be due 
 to the retention in the system of certain morbid and 
 effete matters — some irritating compound in the blood — 
 which ought to be eliminated by the kidneys, and thus a 
 septicemic condition is produced. 
 
 Hoffmann mentions the case of a girl of eighteen, who, 
 on exposure to cold during a journey at the period of 
 menstruation, was seized with symptoms of cerebral 
 congestion, and was dumb for four days, the mind and 
 senses remaining unaffected ; after an evacuant and 
 diaphoretic treatment she entirely recovered.* 
 
 The suspension, more or less complete, of the power of 
 speech which sometimes occurs after continued fever, is 
 probably due to a vitiated condition of the blood circu- 
 lating through the brain. It occurs more frequently 
 after enteric than typhus fever ; Dr. S. Jackson, however, 
 mentions three cases in which typhus coincided with 
 impaired speech ; f Dr. Osborne has recorded three 
 instances of gastro-enteric fever, in which loss of speech 
 occurred without disturbance of the intellect; and 
 Trousseau mentions three cases, one observed by him- 
 self, and two by M. Boucher, of Dijon, in which aphasia 
 occurred during convalescence from fever (dothinenterie) ; 
 in two of these cases there was albumen in the urine.J 
 
 * Op. citato, torn, iii., cap. vii., obs. i. 
 
 t Edinburgh Medical Journal, January, 1847. 
 
 J "Clinique Medicale," torn, iii., p. 618. 
 
276 A SEQUELA OF TYPHOID FEVER ; AND OF MEASLES. 
 
 My friend, Dr. Anatole Manouvriez, of Valenciennes, 
 has kindly sent me the clinical history of a child, aged 
 four, who at the end of the second week of an attack of 
 typhoid fever, suddenly lost her speech, without any 
 intellectual, sensitive, or motor trouble ; the aphasia was 
 complete for seventeen days, then gradually subsided, 
 and at the end of five weeks the power of speech was 
 regained.* 
 
 At a meeting of the Philadelphia Neurological Society, 
 Dr. Ott mentioned the following instance of aphasia 
 occurring after measles : — 
 
 A boy twenty-eight months old was doing well up to the tenth 
 day, when he seemed nearly convalescent, but instead of the dull 
 yellowish stains which remain after the papules of measles have 
 faded, his skin was dotted over with spots of a purplish hue. The 
 same morning his mother noticed a twitching of the muscles of the 
 right eye and right side of the face, and soon after similar move- 
 ments of the right arm and leg. He remained conscious during 
 the spasm, but was unable to speak, motioning for anything he 
 wanted. After the spasm had existed an hour, complete right 
 hemiplegia ensued, with complete aphasia. Here then was a little 
 boy, who talked connectedly and as well as usual for his age, sud- 
 denly stricken with unilateral spasm, followed by hemiplegia and 
 total loss of the power of speech, his intelligence remaining perfect. 
 In the fifth week he used a few monosyllables, and later on simple 
 words were added to his vocabulary, his mother remarking that it 
 seemed as if he had to learn to talk over again. At the sixth 
 month, although talking more, he only used such familiar words as 
 children learning to speak usually employ.f 
 
 Aphasia has also been observed in variola, scarlatina, 
 and erysipelas ; Trousseau has also observed it in a case 
 of diabetes. 
 
 * A full account of this interesting observation is contained in the 
 "Gazette des Hopitaux" for March 17th, 1877, under the title of " Aphasie 
 dans la fievre typhoide chez les enfants." 
 
 + American Journal of Mental and Nervous Disease, April, 1884, p. 256. 
 
PUERPERAL APHASIA ; CEREBRAL ISCHEMIA 277 
 
 In an observation recorded by M. Augier, the aphasic 
 symptoms seem to have been due to a cerebro-meningeal 
 hyperaemia, caused by the excessive use of cider in a 
 person who in early youth had been a great brandy 
 drinker.* 
 
 The puerperal condition, by inducing cerebral ischaemia, 
 may give rise to loss of speech. I have myself recorded, 
 at page 131, a typical instance of this complication, in 
 which lacteal derangement coincided with complete 
 aphasia. We know but little of the effect of lacteal 
 disturbance on the nervous system, and in a recent dis- 
 cussion at the Obstetrical Society of London, Dr. 
 Matthews Duncan commented upon the neglect of the 
 science of lactation, and the deficiency of literature con- 
 nected with this important department of practice. 
 
 A French writer, M. Poupon, after analysing twelve 
 cases of puerperal aphasia collected from various authors, 
 divides loss of speech occurring in the puerperal state 
 into two classes: — 1st, Aphasia due to vascular distur- 
 bances ; 2nd, Aphasia from nervous derangement.f 
 
 In the category of causes we are now considering must 
 be classed the poison introduced into the system by the 
 bite of venomous snakes. M. Ruftz stated at a meeting- 
 of the Paris Anthropological Society, that he had seen a 
 certain number of persons who had completely lost their 
 speech in consequence of a bite from a serpent (Fer de 
 lance) ; sometimes aphasia was produced instantly, and, 
 at other times, some hours only after the bite ; but, what 
 was most remarkable, those who survived the poisoning 
 
 * " Gazette des Hopitaux," March 8th, 1866. 
 
 + Poupon. " Des Aphasies Puerperales." L? Encephale, No. 4, iS 
 P- 393- 
 
278 ETIOLOGY OF APHASIA. 
 
 remained permanently aphasia Van der Kolk quotes 
 the case of a gunner in the Dutch Indies, who was bitten 
 by a serpent called by the natives Oeloer; in a few 
 minutes he became giddy and lost the power of swallow- 
 ing ; there was total loss of speech, but consciousness was 
 unimpaired ; death occurred four hours and a half afte 
 receipt of the injury.* 
 
 I have dwelt thus upon blood poisoning as a cause of 
 impairment of speech, because it seems to me to have an 
 important bearing on the question of localisation of the 
 faculty of articulate language ; for since in our days 
 hitmourism has given way to solidism, there is a tendency 
 to connect all abnormal cerebral symptoms with change 
 of tissue, whereas temporary loss of speech, at all events, 
 does not necessarily require for its production positive 
 lesion of brain substance, any more than jaundice from 
 obstruction and reabsorption of bile, need in all cases 
 imply structural disease of the liver. 
 
 * Dr. W. D. Moore's Translation, p. 162. 
 
CHAPTER IX. 
 
 Diagnosis. — Aphonia ; whispering is in reality an articulate language. 
 Labio-glosso-pharyngeal paralysis. The speechlessness of lunatics. Im- 
 portance of the quantitative analysis of the urine. The Sphygmograph 
 and the Ophthalmoscope. Thermometric observation, and its value in 
 cerebral pathology; thermic exploration of the different cranial regions — 
 Broca, Voisin, Lombard, and Maragliani. Auscultation of the parietes of 
 the cranium. Prognosis — more favourable in traumatic cases. Professor 
 Benedikt's case of tardy development of speech in congenital aphasia. 
 Recovery of speech after suspension of the faculty for twenty years. 
 Treatment— must depend upon the cause which produces it. Electricity. 
 Influence of sudden mental shock. Trephining in traumatic aphasia. The 
 re-education of the nervous centres. 
 
 Diagnosis. — Having in this essay employed the word 
 aphasia in its widest and most general sense, as appli- 
 cable to loss of speech from whatsoever cause, the 
 existence of this defect is so easy of recognition, that 
 but little need be said under the head of diagnosis ; 
 although, as regards the various forms which this defect 
 assumes, and the pathological conditions which give rise 
 to them, the differential diagnosis becomes important. 
 
 I need scarcely observe that aphasia must not be con- 
 founded with aphonia, where the voice is only suppressed, 
 but the faculty of speech remains. Aphonic patients 
 can whisper, but are unable to speak audibly, owing to 
 some affection implicating the tone of the vocal cords, 
 and, as before stated, whispering is in reality an articu- 
 late language ; those persons, therefore, who are thus 
 able to express their ideas, however inaudibly, should 
 not be classed with aphasics. 
 
280 DIAGNOSIS. 
 
 Although it has been stated that this distinction was 
 not observed by the older authors, still, from a careful 
 study of their works, it will be seen that in many 
 instances the confusion was only apparent, and depended 
 on the use of a faulty nomenclature ; for it is evident 
 that the authors themselves were fully aware of the wide 
 difference between these two morbid conditions.* 
 
 Aphasia may be apparent only, instances having 
 occurred in the Eastern Counties' Asylum for Idiots, 
 where children, who for many years had passed for deaf 
 and dumb, unexpectedly gave evidence of the possession 
 of the power of speech. One boy, supposed to be a 
 deaf-mute, was heard one night to sing a chant which 
 had been used at public worship, pronouncing the words 
 distinctly, and giving the tune correctly. Another boy, 
 also passing for a deaf-mute, broke into a violent 
 passion in consequence of something on his slate being 
 rubbed out, and demanded of another lad why he had 
 done it. 
 
 In Labio-glosso-pharyngeal paralysis, the impairment 
 of speech is not of a psychical character, but the result 
 of functional disturbance of the peripheral organs ; it is 
 not the faculty of language, but the power of articulating, 
 that is affected — it is, in fact, a mechanical defect 
 dependent on paralysis of the tongue, lips, and of the 
 muscles of the larynx. 
 
 We must not confound aphasia with the general decay 
 of conversational power observable in general softening 
 
 * Hoffmann uses the word aphonia in the description of his cases, as 
 does also Mr. Carmichael Smith in his extremely interesting paper in the 
 Medical Communications for 1790 ; but it will be seen from a perusal of 
 their clinical histories, that the authors intended to describe instances of 
 inability to articulate. 
 
THE SPEECHLESSNESS OF LUNATICS. 28 1 
 
 of the brain ; such a case is recorded by Dr. Allbutt, 
 where there was softening of the left anterior lobe on its 
 upper surface ; the patient was unable to speak more 
 than a few words, those being, however, for the most 
 part quite appropriate. Dr. Allbutt considered the 
 patient rather mute than aphasic. 
 
 A person may be dumb simply because he has no 
 idea to convey, as in dementia. Insane patients have 
 been known to continue for years without uttering vocal 
 sounds, and this does not arise generally from any 
 paralysis of the organs of speech. Dr. Brierre de 
 Boismont has recorded the clinical history of a lunatic 
 who had not spoken for thirty years, and who, when 
 perseveringly interrogated, gave a kind of a grunt and 
 ran away. About fifteen days before his death, he 
 regained the use of speech, and answered perfectly well 
 all questions put to him. 
 
 In an obscure subject like this we cannot afford to 
 dispense with any of the auxiliary aids to differential 
 diagnosis. With the view, therefore, of determining 
 whether loss of speech depended in any particular case 
 on softening, or whether it was the result of mechanical 
 pressure exercised by a clot or by some morbid growth, 
 it has occurred to me to make a volumetric analysis of 
 the urine, upon the assumption that in cases of softening 
 there would be more disintegration of nervous tissue, 
 and consequently an excess of phosphorus removed from 
 the system.* 
 
 On referring to those among my own cases where a 
 quantitative analysis of the urine was made, it will be 
 
 * I am by no means prepared to say that this assumption is absolutely 
 correct, but whether it be so or not, inquiries in this direction cannot be 
 otherwise than useful. 
 
282 THE QUANTITATIVE ANALYSIS OF THE URINE. 
 
 observed that the results were negative, inasmuch as 
 there was no deviation from the ordinary range, except 
 in one instance — that of the patient Sainty — when the 
 amount of chlorides was 10 parts per iooo, the ordinary 
 range being, according to Beale, from 4 to 8 parts per 
 
 IOOO. 
 
 Although my own experiments in reference to the 
 urine cannot be considered as in any way conclusive — 
 being based on too small a number of cases — I cannot 
 but think, however, that a quantitative as well as a 
 qualitative analysis of the urine is imperatively called 
 for in all cases of obscure cerebral disease ; and since the 
 introduction of the volumetric system, this analysis has 
 become much easier of accomplishment, and ought never 
 to be omitted where the least doubt exists as to exact 
 diagnosis. " How many cases," says Todd, " formerly 
 supposed to be anomalous, are now readily understood 
 by reference to uraemic poisoning through inefficient 
 kidneys."* Renal inadequacy has been shown by Sir 
 Andrew Clarke to be a powerful pathogenetic factor, 
 and many diseases, formerly but little understood, have 
 been traced to kidneys which secreted urine not suffi- 
 ciently rich in the ordinary matters of waste, which it is 
 the business of these organs to discharge from the body. 
 
 The Sphygmograph may render essential service in 
 affording a clue to the probable condition of the arteries 
 
 * Dr. Todd further remarks that there are many other points of interest 
 in connection with the state of the urine in brain disease, which can only 
 be settled by many observers, such as the variations of the phosphates, the 
 quantity of the sulphates and the chlorides ; and whether, in the marked 
 increase or decrease of these salts or elements of the urinary secretion, we 
 can derive any trustworthy aid to determine the inflammatory or non- 
 inflammatory nature of the brain lesion. — "Clinical Lectures on Diseases 
 of the Brain," p. 311. 
 
THE SPHYGMOGRAPH AND OPHTHALMOSCOPE. 283 
 
 of the brain, and thus enable us to form an opinion as to 
 whether aphasic symptoms are due to structural or 
 merely functional disease. Dr. Sansom has kindly com- 
 municated to me the particulars of a case of aphasia, in 
 which Dr. Anstie, on applying the sphygmograph, 
 noticed a decrease of arterial tone, and that there was a 
 decided difference between the two sides. 
 
 From the facility with which we can watch and note 
 the changes in the optic nerve, the Ophthalmoscope may 
 be of use as showing whether the aphasia is dependent 
 upon organic change, or upon some temporary functional 
 disturbance of the brain. 
 
 The researches of Broca, Auguste Voisin, Lombard, 
 and others, show that the study of the cranial tempera- 
 ture is of the highest importance in cerebral pathology 
 generally, and thermometric observation may be of 
 assistance in the clinical recognition of the morbid lesion 
 giving rise to the aphasic symptoms. 
 
 The result of Professor Broca's observations on aphasic 
 patients has been to show an elevation of temperature 
 above the left ear, in those who are the subjects of cere- 
 bral softening. According to the distinguished Parisian 
 Professor, the increase is sometimes two or three degrees 
 centigrade, and in that case it can be appreciated by the 
 hand ; when the rise in the temperature is less, the 
 variation can only be recognised by the aid of the 
 thermometer. M. Broca thinks that when aphasia is the 
 result of progressive atrophy of the third frontal convolu- 
 tion, there is probably a decrease, instead of a rise of 
 temperature, but this fact he has not yet verified.* 
 
 * M. Broca's method of taking the temperature in these cases is as 
 follows : — He takes two perfectly similar thermometers, covers them with 
 little bags of wadding, and then applies them on each side of the head, 
 
284 THE VALUE OF THERMOMETRIC OBSERVATION. 
 
 Shortly before his death, this indefatigable labourer in 
 the field of science instituted a series of experiments 
 with the view of further testing the diagnostic value of 
 the thermic exploration of the head, from which he 
 obtained the following results : — 
 
 In twelve persons examined, he found the temperature 
 of the right side of the head to be 33*90 centig., and that 
 of the left 34, being a difference of only one-tenth of a 
 degree. The examination of the different regions of the 
 head, however, gave the following results : — 
 
 Regions. 
 
 Right side. 
 
 Left side, 
 
 Frontal 
 
 35-28 
 
 35-48 
 
 Temporal 
 
 3372 
 
 33^ 
 
 Occipital , 
 
 32-92 
 
 33-23 
 
 The above statistics have reference to a state of 
 intellectual inactivity in healthy individuals; this ob- 
 server, however, added two pathological cases, and in 
 both instances there was a fall in temperature of about 
 half a degree in the left temporal region. 
 
 Another observer, Dr. Maragliani, of Genoa, says that 
 the temperature of the left side of the head is always 
 higher than that of the right ; and that the temperature 
 of the external orbital angle and behind the ear is higher 
 than that of the external occipital protuberance. 
 
 According to Voisin, the temperature of the cranium 
 by no means coincides with the variations of the 
 axillary temperature ; and the former is often much 
 above normal, when the latter differs but slightly, if at 
 
 fixing them by means of a circular band. It is essential that the two little 
 bags should be of the same thickness, weight, and form. At the end of 
 ten minutes he reads off the position of the mercury, and marks the 
 difference. 
 
AUSCULTATION OF THE CRANIUM. 285 
 
 all, from the healthy standard. He also found that an 
 encephalic local hyperthermia may exist without the 
 coincidence of febrile symptoms. The points of the 
 cranium upon which M. Voisin makes his investigations 
 are the following : — The middle of the forehead ; behind 
 the ears; over the bregma; over the superior occipital 
 protuberance ; and over the temples.* 
 
 Although I have thought it right to make a brief 
 allusion to the diagnostic value of thermometric observa- 
 tion, the results are somewhat conflicting, and I think it 
 would be unsafe to draw any positive conclusions from 
 cerebral thermometry in the present state of our know- 
 ledge of this subject. 
 
 A refinement in diagnosis has been suggested by an 
 Italian physician, Dr. Adriani, who, relying upon the 
 fact that on applying the hand upon the head of a per- 
 son speaking, a vibration is felt, has suggested that in 
 certain cerebral affections the modification of the voice 
 might be transmitted to the ear of the observer by 
 auscultation of the parietes of the cranium. f I am far 
 from laying any stress upon this mode of investigation 
 in the diagnosis of the various conditions of the brain 
 causing aphasia, but I can conceive it possible that 
 further researches in this direction may lead to satisfac- 
 tory results. 
 
 Prognosis. — Some authorities have considered sudden 
 loss of speech as necessarily indicative of grave cerebral 
 
 * A. Voisin. " Etude sur la Temperature des parois de la tete." I wish 
 to direct especial attention to this important essay, which was read by its 
 author at the International Congress of Mental Medicine, held at Paris in 
 1878. 
 
 f ''Archives de Neurologie," 1882, V. iv., p. 117. 
 
286 PROGNOSIS. 
 
 disorder. Dr. Winslow says it is most unusual for 
 sudden speechlessness to exist without being immediately 
 followed by acute cerebral symptoms. Dr. Copland 
 seems to share the same opinion, for in his work on 
 Palsy and Apoplexy, he says that " loss of the power of 
 articulation, except in hysterical cases, is either attendant 
 on, or followed by, the most complete or fatal states of 
 palsy or apoplexy." Trousseau also considers the 
 aphasia which is accompanied by hemiplegia, of the 
 most serious import, and alludes to its frequent termina- 
 tion by " apoplexie foudroyante" giving three instances in 
 which this fatal result ensued.* 
 
 A glance at the observations which I have recorded in 
 the preceding pages, will show that loss of speech, 
 although often of ominous and serious portent, is not 
 unfrequently perfectly amenable to treatment, the func- 
 tion being sometimes completely restored in a very short 
 time. The Prognosis, however, must necessarily depend 
 on the cause which has given rise to the symptom ; when 
 it occurs as a sequel of continued fever, when it occurs as 
 a neurosis, or is of hysterical origin, or when it arises 
 from any moral cause, a recovery may be anticipated. 
 The intercurrence of an exanthematous fever may coin- 
 cide with a marked improvement, as was observed in a 
 young girl under the care of M. Peter, at La Pitie, Paris, 
 when a rapid cure supervened on the occurrence of an 
 attack of measles.f A favourable result may be antici- 
 pated in aphasia of nervous origin, when the disturbance 
 of speech occurs suddenly, and disappears rapidly. The 
 age of the patient is an important element in the chances 
 of recovery, and, as Kiissmaul observes, children have 
 
 * " Clinique Medicare," torn, ii., p. 625. 
 
 t Lacambre. "These de Paris," 1869, p. 60. 
 
PROGNOSIS. 287 
 
 been known to regain their speech after very extensive 
 destruction of the cortex of the left hemisphere. 
 
 Loss of speech in a patient whose heart, arteries, and 
 kidneys are healthy, is of a different import to when 
 there exists degenerative changes of these organs ; in 
 such instances the disturbance of speech is a small 
 matter in comparison with the state of the system of the 
 patients themselves. 
 
 I am inclined to think that the prognosis is more 
 favourable when loss of speech depends upon direct 
 injury to the brain; in the three cases of traumatic 
 aphasia that I have mentioned as occurring under my 
 own observation, the improvement was comparatively 
 rapid, and attended by no relapse. Romberg mentions 
 an instance of perfect re-establishment of the power of 
 language after fracture of the frontal bone involving the 
 orbit, from severe injury to the left side of the skull. 
 
 The chances of the complete restoration of the faculty 
 are also much greater when the aphasia is simple and 
 uncomplicated with any paralytic symptom. When 
 hemiplegia co-exists with aphasia, the return of motor 
 power usually coincides with a corresponding improve- 
 ment in speech ; this, however, is not always the case, as 
 for instance in the observation of Sir Thomas Watson, to 
 which I have already alluded, where, although the 
 paralysis disappeared, there was no corresponding ameli- 
 oration in the power of articulation.* 
 
 * In reference to the persistence of amnesic aphasia after the disappearance 
 of all other morbid cerebral symptoms, Van Swieten has the following 
 passage : — " Vidi plures, qui ab apoplexia curati omnibus functionibus cerebri 
 recte valebant nisi quod deesset hoc unicum, quod non possent vera rebus 
 designandis vocabula invenire ; manibus, pedibus, totius corporis nixu 
 conabantur explicare miseri, quid vellent, nee poterant tamen. Malum 
 il'ud oer plures annos ssepe insanabile perstat." Van Swieien — Commentaria 
 in Bcerkua-j., torn. iii. § 101S. t 
 
288 RECOVERY OF SPEECH AFTER SUSPENSION 
 
 When aphasia coincides with hemiplegia in elderly 
 people, the ultimate prognosis is bad, for although some 
 temporary improvement may ensue, a relapse is likely to 
 occur. This, however, is not invariably the case ; I am 
 acquainted with a gentleman, who, at the age of sixty- 
 one, had an attack of right hemiplegia with aphasia, and 
 who, having had no relapse, now twelve years after the 
 attack, is able to express himself with comparative 
 fluency, with the exception of occasional forgetfulness of 
 words. Moreover, aphasia complicating hemiplegia may 
 persist for many years without apparently materially 
 affecting longevity. I have had under my observation a 
 lady, who, at the age of fifty-eight, had an attack of 
 partial hemiplegia, with complete aphasia ; on recovering 
 from the paralysis, the total loss of speech continued till 
 her death, which only occurred eleven years after the 
 paralytic attack. 
 
 The prognosis, also, is not necessarily hopeless when 
 the loss of speech occurs in early life and persists during 
 many years. Whilst engaged in writing this chapter, I 
 have been favoured with a private communication from 
 Professor Benedikt of Vienna, in which he gives an in- 
 stance of tardy development of speech in a case of 
 congenital aphasia ; the faculty of articulate language 
 began to manifest itself as late as the age of twelve years. 
 
 A case is recorded by M. Charpentier of a boy, 
 who, at the age of five years, as the result of an 
 accident to his head, became quite speechless; this com- 
 plete suspension of language lasted for twenty years, 
 when, under the influence of electricity and other 
 remedies, he suddenly recovered the power of speech. 
 The case is of such exceptional interest that I append its 
 leading- features : — 
 
OF THAT FACULTY FOR TWENTY YEARS. 289 
 
 The patient was an inmate of Bicetre, without any cerebral, 
 neurotic, or diathesic antecedent. The only abnormal symptom in 
 early childhood was that he only began to talk at the age of three 
 years ; but from that period till the age of five years and a half, he 
 spoke like other children. He had never been deaf, never had 
 convulsions, and had never stammered ; moreover, his language, 
 intelligence, and general behaviour were those of other children of 
 his age. 
 
 When he was five years and a half old, he was one day brought 
 home from school with his head covered with bandages stained 
 with blood ; his parents had never been able to ascertain what had 
 happened. The child got well without any loss of consciousness, 
 delirium, convulsions, or paralysis ; but from that moment he 
 became dull, speechless, and, to use the words of his mother, he 
 had become " like a mummy, silent, and concentrated upon him- 
 self.'' This state of things persisting, at the age of 14, he was 
 placed at Bicetre. 
 
 After he had been in the hospital about a year, M. Charpentier 
 wished to try the effect of electricity. On the third application of 
 the electric current, he said several times "Pardon, Monsieur." 
 On the fourth day, on entering the ward, M. Charpentier was sur- 
 prised to see the patient sitting up in bed, with a smiling counten- 
 ance ; he welcomed his physician with a volley of words spoken 
 very rapidly — too rapidly even, (a la maniere de nos persecutes 
 loquaces) ; the style of his conversation was childish and silly, but 
 what astonished those around him, was to hear him employ ex- 
 pressions which he could not have known at the commencement of 
 his disorder, when he was only five years old. 
 
 Here, then, says M. Charpentier, was a patient, who, 
 from the age of five to twenty-five years, could only say 
 two or three words, always the same, and who suddenly 
 began to speak and to use words and expressions which 
 he must have acquired since, and notwithstanding, his 
 mutism and his apparent stupidity. In further comment- 
 ing upon this singular chain of morbid symptoms, 
 M. Charpentier inquires whether there was not here 
 
29O TREATMENT. 
 
 tine emotivite particuliere, the result of inhibition of 
 the faculty of language.* 
 
 Treatment — Having admitted that aphasia is only a 
 symptom, and not a disease of itself, its treatment must 
 obviously depend upon the cause which produces it, 
 and must be based upon a precise knowledge of the 
 physiological and pathological conditions underlying the 
 abnormal mental phenomena. Still, some practical good 
 may result from a brief consideration of the mode of 
 treatment applicable to the various forms of loss or 
 lesion of speech which are observed in practice ; and at 
 the same time the pathology of this obscure symptom 
 may perhaps receive some elucidation from a brief 
 analysis of the therapeutical measures, which have been 
 more or less successfully adopted in the numerous cases 
 which have now been submitted to the profession. 
 
 In those cases that are associated with hemiplegia, and 
 where there is structural disease to account for it, there 
 can be no special treatment for the aphasic complication ; 
 but in those instances where loss of speech is the sole or 
 principal symptom, medical science may do something 
 toward removing the morbid condition. 
 
 When the defect seems to depend on the circulation 
 of some morbid product through the brain, in conse- 
 
 * Annales Medico-Psychologiques, March, 1886, p. 265. The recital of 
 the above case at the Medico- Psychological Society of Paris, gave rise to 
 an animated discussion, in which MM. Briand, Christian, Dally, and 
 Gamier took part ; the last two speakers maintaining that during the long 
 period of his mutism, the patient must have retained the mental language — 
 le langage interieur, or he would not have been able to recover the power 
 of speech. 
 
TREATMENT. 29 1 
 
 sequence of some irritating matter in the blood, whether 
 from faulty kidneys or sluggishness of other secreting 
 organs, a treatment actively eliminatory will be found 
 beneficial. Long before the attention of the profession 
 was specially called to the lesion of articulate language, 
 a remarkable instance of recovery of the power of speech 
 after free purging, which brought away several fetid 
 dark-coloured stools, was observed by Dr. Richard 
 Jones.* A French physician, M. Mattel, has seen aphasia 
 the consequence of constipation entirely removed by 
 repeated injections ; after giving minute details of this 
 case, which is full of interest, he says, "La malade a 
 rempli en une demi-heure trois cuormcs vases de mat it res 
 feeales, et lorsque Vintestiu a ete tout a fait vide la parole 
 est devenne anssi precise que si lafemme iiavait rien eu."f 
 
 As far back as 1790, Dr. J. Carmichael Smith has re- 
 corded a case of loss of speech of some months' duration, 
 which yielded to an emetic.^ 
 
 Surely the successful treatment of such cases as the 
 above is very significative in reference to the question of 
 localisation, and must be a source of difficulty to those 
 who adhere to the doctrine of a separate and limited 
 centre for speech. 
 
 When the aphasia has a syphilitic origin, or may be 
 due to a tumour compressing the cerebral substance, 
 Iodide of Potassium or Mercurials may be beneficial. 
 At page 207, I have quoted a case reported by M. Pitres, 
 in which a vigorous antisyphilitic treatment restored the 
 speech in eight days. 
 
 * Edinburgh Medical Journal, 1809, p. 281. 
 
 t Gazette des Hopitaux, June 15, 1865. 
 
 % Medical Communications, Vol II., p. 488. London, 1790. The par- 
 ticulars of this case are of extreme interest, as also those of two others 
 described in the same communication. 
 
292 ON ELECTRICITY AS A THERAPEUTICAL 
 
 Venesection or abstraction of blood by leeching or 
 cupping may occasionally be useful where the morbid 
 condition is dependent on temporary congestion, or on 
 disturbance of the hydraulics of the blood ; in the case 
 of Professor Rostan, as well as in that I have quoted 
 from Dr. Jackson, of Pennsylvania, speech was rapidly 
 restored by the abstraction of -a little blood. When we 
 have reason to infer that the brain lesion is of an irrita- 
 tive character — as perhaps indicated by early rigidity of 
 the paralysed muscles, and by their extreme sensibility 
 to the galvanic stimulus — we are justified in expecting 
 some benefit from the abstraction of blood ; where an 
 opposite condition exists, bleeding will probably be 
 worse than useless. 
 
 When loss of speech occurs in hysterical and highly 
 excitable persons, or is an accompaniment of the choreic 
 or epileptic condition and may depend on a spasmodic 
 state of the cerebral arteries, diffusive stimulants and 
 antispasmodics will be found of service. Crichton men- 
 tions a case in which large doses of Valerian were effectual, 
 and Dr. Hutchison, of the United States, has recorded a 
 case where hysterical loss of speech was cured by 
 Etherisation* 
 
 The value of Electricity as a therapeutic agent in dis- 
 eases of the brain has of late been duly recognised, and 
 the numerous works that have appeared on this subject 
 have awakened in the profession a sense of the important 
 position occupied by this agent in neuro-pathology. 
 There are certain cases in which the aphasia seems to 
 depend on a kind of cerebral catalepsy, and where very 
 powerful stimulants, such as electricity, prove of great 
 
 * Medical Times, July 29th, 1865. 
 
AGENT IN THE TREATMENT OF APHASIA. 293 
 
 value. I have elsewhere stated that in one of my own 
 cases, that of Sutherland, electricity had a decidedly 
 baneful effect; and in this affection, as well as in motor 
 paralysis, this powerful remedial agent must be used 
 with the greatest caution. In reference to its use, we 
 cannot do better than observe the distinction laid down 
 by Dr. Todd — that electricity is injurious when there 
 is an early tendency to muscular rigidity, showing an 
 exalted polarity of nervous tissue, and probably an 
 irritating lesion of the brain ; thus, when the aphasia 
 is an accompaniment of muscular paralysis, the result 
 of electricity on the limbs affected may serve to guide us 
 in our diagnosis, by showing whether the lesion is 
 irritative or depressing. 
 
 In the Lancet, for January 23rd, 1869, Dr. Marcet has 
 mentioned a striking instance of the benefit of electricity 
 in a case of hemiplegia with aphasia, where, after re- 
 covery from the paralysis, the loss of speech continued. 
 Dr. Marcet, having determined to try galvanism with 
 Smee's battery, one of the electrodes was applied, by 
 means of Mackenzie's galvaniser, to the tongue, and the 
 other to the back of the neck, in contact with the spine. 
 Speech began to return from the very first application of 
 the galvanism, and continued steadily to improve each 
 time it was used. 
 
 There cannot be a doubt that electrical influences 
 cause molecular changes of which we know but little, 
 except that modification of function is the result. I 
 should be disposed to try electricity in temporary and 
 emotional aphasia as tending to improve the condition 
 of the circulation of the parts concerned in the mechanism 
 of speech ; for, as Radcliffe says, it is more than probable 
 that the beneficial effects of electricity in the resuscitation 
 
294 INFLUENCE OF SUDDEN MENTAL SHOCK IN 
 
 of the paralysed parts arc as much brought about in- 
 directly by changes produced in the circulation, as by 
 changes wrought directly in the nerves and muscles. 
 
 Strong mental emotion is often salutary in such cases ; 
 we are all familiar with the story in Herodotus of the 
 son of Croesus, who had never been known to speak, but 
 who, at the siege of Sardis, being overcome with astonish- 
 ment and terror at seeing the king — his father — in 
 danger of being killed by a Persian soldier, exclaimed 
 
 aloud — kvPpmne [irj ure'ive lipoicrov — Oh, man, do not kill 
 
 Crcesus ! This was the first time he had ever articulated, 
 but he retained the faculty of speech from this event as 
 long as he lived.* Herodotus is universally admitted to 
 be a trustworthy historian, but if it be thought far-fetched 
 to illustrate a subject by allusion to a work written 500 
 years before the Christian era, I may add that such 
 cases have been met with by other observers. The late 
 Mr. Dunn has recorded a similar one, and a few years 
 ago, I myself was invited by Mr. Allen, of Norwich, to 
 see with him a man, aged 37, who had been in his usual 
 health up to the day preceding my visit, when, during a 
 meal, his wife noticed that all his limbs were shaking, 
 and from this time he became speechless. The suspen- 
 sion of speech was unaccompanied by any symptom of 
 
 * Herod. Hist. I., 85. Aulus Gellius, after repeating the above story from 
 Herodotus, relates a similar fact in the following terms : — Sed et quispiam 
 Samius athleta, nomen illi fuit AiyX^s, quum antea non loquens fuisset, ob 
 similem dicitur causam loqui ccepisse. Nam quum in sacro certamine 
 sortitio inter ipsos et adversaries non bona fide fieret, et sortem nominis 
 falsam subjici animadvertisset, repente in eum, qui id faciebat, sese videre, 
 quid faceret, magnum inclamavit. Atque is oris vinculo solutus, per omne 
 inde vitse tempus, non tuibide neque adhsese locutus est. Noctes Atticas, 
 lib. v., cap ix. 
 
ROUSING THE DORMANT FACULTY OF LANGUAGE. 295 
 
 paralysis, and the loss of the faculty of articulate lan- 
 guage continued for six days, when being asleep on his 
 couch, he suddenly started up, and was heard to say 
 three times, "A man in tlie river!" From this moment 
 speech was restored, and when I saw him an hour after- 
 wards, he told me that he had dreamed that a man was 
 falling into the river; the mental shock produced by 
 this dream was salutary, for it resuscitated the previously 
 dormant faculty of articulate language. 
 
 Dr. VVigan mentions a similar example of the sudden 
 excitation of speech. A London merchant had a son, 
 eight years old, perfectly dumb, and the family had 
 abandoned all hope of his ever being endowed with the 
 gift of speech ; there was no defect in the intellect nor 
 lesion of any other faculty. In a water party on the 
 Thames, the father fell overboard, when the dumb boy 
 called out aloud, " Oh, save him ! save him ! " and from 
 that moment, he spoke with almost as much ease as his 
 brothers, and eventually entered his father's business.* 
 
 Again, Wiedermeister relates the history of a female 
 who became speechless as she left her wedding breakfast 
 to start on her bridal trip with her husband, and who 
 remained so until she happened to see a church burning, 
 when she cried out, " Fire ! " and at once regained the 
 power of speech. f 
 
 Ireland, in commenting on such cases, says, '' Probably 
 the injured nerve centres or conducting tracts have for 
 sometime recovered their lost capacity, but through dis- 
 use and wasting, do not resume their functional activity 
 till stimulated by some sudden mental excitement or 
 
 * "The Duality of the Mind." 1844, p. 377. 
 
 t Albg. Zeitschr. f. Tsych. 1874. Bd. 28, s 485. 
 
296 TREPHINING IN TRAUMATIC APHASIA. 
 
 electric shock, when they respond with a start, and after- 
 wards continue to act."* 
 
 The remarkable advance that has recently been made 
 in Brain Surgery, and the unprecedented results that 
 have been obtained, must materially influence the treat- 
 ment of cases of traumatic aphasia. To old practitioners 
 the brain area was considered as practically inviolable, 
 and as "a dark continent in which they could descry 
 neither path nor guide capable of leading them to a 
 particular diseased area, and, did they attempt to reach 
 it, it could only be by groping in the dark." In the 
 case I have quoted from Th Simon, at page 259, there 
 cannot be a doubt that the operators of the present 
 decade would have attempted some surgical interference 
 by which the speech might have been restored, and the 
 life of the patient prolonged. At a recent meeting of 
 the surgical section of the Royal Academy of Medicine 
 of Ireland, three successful cases of trephining were re- 
 ported, one of which, that mentioned by Dr. C. D. Ball, 
 has a striking bearing upon our subject. 
 
 A boy had been struck with a small knife over the squamous 
 portion of the left temporal bone ten days before he came under 
 observation at Sir Patrick Dun's Hospital. The wound was healed, 
 but he had some aphasia. Pain in the head and ear supervened, 
 and the aphasia increased. It was determined to explore, and he 
 was trephined some weeks after the original injury, when a wound 
 was found in the dura mater corresponding to the puncture of the 
 bone. A sinus forceps was passed in, the wound opened up, and 
 some blood clot escaped ; the patient was decidedly better, but 
 next morning he was again aphasic. The wound was washed out, 
 and more blood clot escaped ; the aphasia almost immediately 
 disappeared, but two days later it returned, and the wound was again 
 
 * On Thoughts without Words. "Journal of Mental Science," Oct., 
 1S78, p. 438. 
 
RE-EDUCATION OF THE NERVOUS CENTRES. 297 
 
 washed out. After this the patient progressed favourably, and 
 entirely recovered. 
 
 At the same meeting at which the above clinical 
 history was related, Professor Thornley Stoker and 
 Sir William Stokes mentioned similar instances of the 
 success obtained by them by trephining, the record of 
 which cannot fail to influence the views of the profession 
 as to the possibility of giving relief in a class of cases 
 hitherto considered as beyond the reach of surgical aid. 
 
 In our efforts at the restoration of speech, we must 
 not lose sight of the fact that as muscles from want of 
 use, lose their contractile power and become atrophied, 
 so it is possible that the convolution or portion of brain 
 presiding over articulate language — assuming pro hdc vice 
 that there is such a localised centre— may, from long 
 disuse and actual cessation of function, undergo a 
 change of some kind, by which the patient may be some- 
 what in the same condition as that of a child who has 
 not yet learned to speak; thus, one of the most interest- 
 ing features in the treatment of certain cases of aphasia 
 is the education of the organs of the speech, as it were, 
 de novo. 
 
 Several instances have been recorded confirmatory of 
 this view. M. Piorry relates the history of a merchant 
 who had to re-learn his a b c* Dr. Bank's case of the 
 gentleman re-learning Greek and Latin is a further 
 illustration, as also the remarkable observation of Dr. 
 Hun, which I have recorded when treating of the 
 American contributions to this subject, f Perhaps, one 
 of the most satisfactory results of efforts to re-learn to 
 
 * Gazette des Hopitaux, May 27, 1865. 
 
 + Vide Journal of Mental Science, Apt il, 1868. 
 
298 TREATMENT. 
 
 speak is that recorded by Dr. Osborne, in connection 
 with his remarkable case to which I have already alluded 
 under the head of Varieties. Dr. Osborne says: — 
 " Having explained to the patient my view of the 
 peculiar nature of his case, and having produced a com- 
 plete conviction in his mind that the defect lay in his 
 having lost, not the power, but the art of using the 
 vocal organs, I advised him to commence learning to 
 speak like a child, repeating first the letters of the 
 alphabet, and subsequently words after another person. 
 The result has been most satisfactory, and affords the 
 highest encouragement to those who may labour under 
 this peculiar kind of deprivation ; there being now very 
 little doubt, if his health is spared, and his perseverance 
 continues, that he will obtain a perfect recovery of 
 speech."* 
 
 Perhaps a still more remarkable instance of the success 
 attending persevering and systematic efforts to instruct 
 a patient in articulation, and to set in motion the 
 mechanism of speech, is recorded by Dr. Bristowe in his 
 Lumlean Lectures on the Pathological Relations of the 
 Voice and Speech. The case is reported at considerable 
 length, but it presented a combination of phenomena of 
 such exceptional interest, that I have subjoined a con- 
 densed account of its leading features. 
 
 A Canadian, aged 36, after a series of epileptic fits, lost the power 
 of speech, and became stone deaf. He remained deaf and dumb 
 for six weeks, when he regained his hearing. At the end of seven 
 months, he was still unable to utter a single articulate sound ; he 
 seemed intelligent, and could understand all that was said to him ; 
 lie could read to himself, and he understood everything that he 
 read ; he could, moreover, maintain a conversation of any length, 
 he writing on his slate and his interlocutor speaking. 
 
 * Dublin Journal of Medical Science, Nov. 1833, p. 169. 
 
RE-EDUCATION OF THE NERVOUS CENTRES. 299 
 
 As he could perform with his lips, tongue, and jaws, all varieties 
 of voluntary movements, and was also capable of vocal intonation, 
 Dr. Bristowe came to the conclusion that his inability to speak was 
 probably due to his having forgotten how to combine automatically 
 the movements of these organs, so as to obtain from them the 
 elementary sounds which, in combination, constitute articulate 
 speech, and he determined to teach him. 
 
 He informed the patient of his views of his case, which the latter 
 appeared to understand perfectly. He explained to him that 
 ordinary vocal sounds are composed of two factors, namely, 
 laryngeal intonation, which he was still able to produce ; and 
 articulation effected by the lips, tongue, and associated parts, of 
 which he was as yet incapable. He then got him to sound a 
 laryngeal note, subsequently explaining to him, and showing him 
 how to modify the shape and size of the oral passage and aperture ; 
 and getting him at the same time to expire, either with or without 
 laryngeal intonation, he made him sound, both in a whisper and in 
 a loud voice, certain of the more simple and obvious vowel sounds. 
 
 At his next lesson, he set to work to teach him the labials, and 
 he subsequently taught him by the same process the lingual and 
 guttural consonantal sounds ; and thus, in the course of four or five 
 lessons, principally by making the patient watch the movements of 
 his (Dr. Bristowe's) lips, he regained the power of articulating all 
 the simple vowel and consonantal sounds. He then began to teach 
 him to combine letters, and eventually succeeded in making him 
 talk well, although he spoke somewhat slowly and evidently had to 
 give more thought to the pronunciation of his words than healthy 
 people ordinarily do. 
 
 However hypothetical, therefore, the re-education of 
 the nervous centres may, at first sight, appear, there 
 exists sufficient evidence to induce us, in all cases where 
 cerebral loss of speech is unattended by any marked 
 lesion of the intelligence, to endeavour gradually to 
 rouse into action the complex apparatus, the concurrence 
 of which is necessary for the re-establishment of man's 
 noblest prerogative — the Faculty of Articulate Language. 
 
CHAPTER X. 
 
 On the Jurisprudence of Aphasia — French and German writers on this 
 subject. Loss of Speech may affect both civil and criminal responsibility. 
 The testamentary capacity of aphasics — a speechless Mayor; the validity 
 of wills made by the deaf and dumb ; remarkable case of a testator 
 disposing of a large fortune by means of gesture language. On the 
 capacity of speechless persons to manage their affairs generally; important 
 case submitted to the Medico- Legal Society of Paris. The medico-legal 
 aspect of the author's own cases recorded in this treatise. Word-blindness 
 and Word-deafness may throw doubts upon testamentary capacity. Articu- 
 late language is not the only medium of thought and of expression ; — the 
 outward sign may be verbal, vocal, graphic, or mimic. Aphasia does not 
 necessarily entail testamentary incompetency, or inability to discharge civil 
 or social functions. 
 
 Ox the Jurisprudence of Aphasia. Under this head, 
 I propose to consider what modifications, if any, the 
 aphasic condition may necessitate in the civil rights of 
 the individual affected with this infirmity. 
 
 Questions of law have often arisen in our courts of 
 justice in connection with persons deprived of the faculty 
 of speech — whether such persons are to be considered to 
 possess testamentary capacity ; and whether, also, in 
 other respects, they are legally responsible units in the 
 social scale. 
 
 I am not aware that this important and interesting 
 subject has been treated by any British writer ; at all 
 events, no systematic essay on the legal aspect of 
 aphasia has come under my notice ; some very important 
 
THE TESTAMENTARY CAPACITY OF APHASICS. 301 
 
 communications, however, luive issued from the French 
 press, amongst others, those of Lasegue, Jules Falret, 
 Legrand du Saulle, Gallard,* &c. ; and at a congress of 
 German alienists held at Carlsruhe, Professor Jolly read 
 a communication on the capacity of aphasic persons to 
 testate, with a critical analysis of the views of German 
 medical-jurists upon this point. 
 
 As I believe there is no code or law as to the legal 
 capacity of aphasics, either in this or in any other 
 country, and as, therefore, each particular case would 
 have to be considered on its own merits, and dealt with 
 according to its own peculiarities, I propose giving a 
 brief sketch of the precedents which have been brought 
 under my notice. 
 
 . Loss of speech may affect both the criminal and civil 
 responsibility of the person so affected ; the latter, which 
 has been the most frequent subject of investigation, in- 
 volves the question of the management and disposal of 
 property, and the validity of a will. 
 
 I will first consider the testamentary capacity of 
 aphasics. A will is one of the most solemn acts of 
 social life, and its importance is attested by the scru- 
 pulous formalities with which legislators, in all ages and 
 in all countries, have invested this document. There is 
 something immutable about the expression of the last 
 wishes of an individual, whose instructions are to be 
 carried out when he himself shall have disappeared from 
 the scene. 
 
 * L'aphasie au point de vue de la medecine legale. This formed the 
 subject of one M. Gallard's clinical lectures at La Pitie, a complete analysis 
 of which is given in Le Journal de Medecine et de Chirurgie pratique, tome 
 48. p. 37§- 
 
302 THE JURISPRUDENCE OF APHASIA. 
 
 As far back as 1743, long before the attention of the 
 profession had been directed to the subject of aphasia, a 
 resident of Munden, who was deprived of the power of 
 speech, applied to the Hanoverian government for per- 
 mission to make a will in favour of his wife, by means of 
 signs ; and the Court acknowledged the validity of the 
 act.* 
 
 An aphasic discharged during a period of five years 
 the functions of mayor and of municipal councillor, by 
 simply writing his name to the necessary documents, 
 which he had learnt to do with his left hand. He also 
 with his left hand wrote, at intervals, a holographic will, 
 perfectly correct in every respect ; the validity of this 
 document was recognised by the law court. f 
 
 John Geale, of Yateley, yeoman, deaf, dumb, and unable to 
 read or write, died leaving a will which he had executed by 
 putting his mark to it. Probate of this will was at first 
 refused, on the ground that there was not sufficient evidence of 
 the testator's understanding and assenting to its provisions. At a 
 later date, however, a fresh application was made to the Court, 
 when the widow and attesting witnesses explained the signs and 
 gestures by which the deceased informed them that the will was 
 the instrument which was to deal with his property upon his death, 
 and that his wife was to have all his property in case she survived 
 him : — -The said John Geale first pointed to the said will itself, then 
 he pointed to himself; he then laid the side of his head upon the 
 palm of his right hand with his eyes closed, and lowered his 
 right hand towards the ground, the palm of the same hand being 
 upwards. These latter signs, it was stated, were the usual signs 
 by which he was in the habit of referring to his own death, or the 
 decease of some one else. He then touched his trousers pocket 
 (which was the usual sign by which he referred to his money); 
 then he looked all round and simultaneously raised his arms with 
 
 * Hofhauer — Traite de Medecine Legale. Paris, 1827. 
 t Billod — Annales Medico-psychologiques, tome xviii. 
 
TUG VALIDITY OF WILLS MADE BY DEAF-MUTES. 303 
 
 a sweeping motion all round (which was the usual sign by which 
 he referred to all his property). He then pointed to his wife, and 
 afterwards touched the ring-finger of his left hand, and then placed 
 his right hand across his left arm at the elbow, which latter signs 
 were the usual signs by which he referred to his wife. 
 
 After the above explanation, Probate was granted by the Court.* 
 
 Application for Probate was made to the Court, May 26th, 1870, 
 under the following circumstances : — George Brook, the testator, 
 was born deaf and dumb ; he married a lady who was also deaf 
 and dumb. Although a deaf-mute, he learned to read and write. 
 He made a will appointing his father universal legatee and 
 executor. Testator's son, Samuel Brook, disputed the will on the 
 ground that the testator did not know and approve its contents. 
 The deaf-mute widow, and some other deaf and dumb witnesses, 
 were examined in support of the objection raised by Samuel Brook. 
 On the other hand, the medical attendant of the testator, who was 
 one of the attesting witnesses, proved that before signing the will, 
 the testator took it in his hand, and appeared to read it, and then 
 wrote a declaration that it was his will. 
 
 The Court came to the conclusion that the testator knew and 
 approved the contents of the will, and pronounced for it, and 
 ordered probate to be granted. f 
 
 In the above two cases deaf-mutism was very properly 
 not considered by the Court as a bar to the disposal of 
 property by will, as it is clear that in both instances the 
 testators were able to give proof that they understood 
 and approved the contents of the will; the former by 
 gesture language alone, the latter by gesture and written 
 language combined. 
 
 Those born deaf are incapable of speech, owing simply 
 to their want of appreciation of sound ; they have the 
 capacity for speech, but from want of the .faculty of 
 
 * Tylor — Early History of Mankind, p. 28. 
 t The Times, May 27th, 1870. 
 
304 GESTURE LANGUAGE EMPLOYED INSTEAD 
 
 hearing, it cannot be called into action ; they can, how- 
 ever, express their thoughts by writing and by certain 
 movements of the fingers. 
 
 Cases, however, may occur where, from serious cerebral 
 and complicated disturbance, a still greater difficulty 
 may exist in clearly ascertaining the testamentary 
 capacity of the patient ; and this difficulty is well illus- 
 trated by a cause celebre, in which the contending parties 
 were resident in my own immediate neighbourhood. 
 
 The testator, the Rev. J. T. L., a widower, 63 years of age, was 
 engaged to be married, when he was suddenly seized with right 
 hemiplegia and aphasia. Although unable either to speak or to 
 write, he could make himself understood by those around him by 
 signs ; and by the language of gesture he succeeded in conveying to 
 his medical attendants that he desired to make a testamentary 
 disposition in favour of Miss R., whom he had intended to make his 
 wife. 
 
 A card was procured and upon it, by the direction of the testator, 
 the following words were written: — " ^30,000 to Miss R., to be 
 tied up to her for life, and after her death to come back to my 
 family, and be divided fairly and equally." 
 
 This document was written by one of the medical attendants ; 
 the testator then made a mark, not at the bottom, but in the middle, 
 of the card, through the word " life ; " one of the doctors then wrote 
 diagonally from this mark towards the right hand upper corner of 
 
 the card the words " Mr. L 's mark," and they both 
 
 attested the execution of the document by placing their initials on 
 the back of the card, with the words, " Witnesses to mark," and 
 followed by the date, November 20th, 1885. Evidence was pro- 
 duced to prove that he subsequently showed this card to the lady 
 whom he had intended to benefit, telling her that it was for her, 
 and that he wished her to keep it. 
 
 The mode in which the testator communicated his wishes were 
 as follows : — He made signs for writing materials ; his wishes were 
 interpreted by means of signs, and then written down on the card. 
 He held up his hand, extended his five fingers, and he was asked if 
 
OF SPEECH IN MAKING A WILL. 305 
 
 he meant "thousands;" he bowed, assent. He then closed his 
 hand, and opened it in the same way, implying ten ; this operation 
 was repeated till it amounted to thirty, and then he dropped his 
 arm down. Testator was then asked whether he wished Miss R. 
 to have thirty thousand pounds, and he nodded his head. In order 
 that there might be no mistake about his wishes as to details, he 
 was asked whether Miss R. was to have this sum absolutely ; he 
 signified dissent, but on being asked if it was to be hers for life and 
 afterwards revert to his family, he bowed his head.* 
 
 It will be observed that the nature of the testator's 
 wishes was ascertained principally by putting questions, 
 to which he signified approval or dissent by nodding or 
 shaking his head as he lay in bed. The amount of the 
 bequest he wished to make was ascertained by opening 
 and shutting the digits of his hands, to represent 
 thousands, and by the testator signifying approval when 
 the sum of thirty thousand pounds was thus reached. 
 
 From a consideration of the above facts, it seems clear 
 that the witnesses did correctly interpret the meaning 
 of the testator's signs, which evidently expressed his 
 testamentary wishes ; his gestures answered to rational 
 conceptions, and were therefore external but not oral mani- 
 festions of the verbum mentale ; and this view was taken 
 by the President of the Court, who held that the writing 
 on the card constituted a valid testamentary document, 
 that the writing of the witnesses on the back of the card 
 was also a sufficient attestation, and that the will would 
 have been allowed to stand if the testator's mark had 
 been placed at the bottom or foot of the card ; but as the 
 mark was made in the middle of the card, its position was 
 not such as to satisfy the provisions of the Statute of 
 
 * Law Report?, Probate Division, Vol. xii., 1887, p. 8. 
 
306 ON THE CAPACITY OF SPEECHLESS PERSONS 
 
 the Wills Act (iv. Vic, chap. 26, sec. 9), or of Lord St. 
 Leonard's Act (xv. Vic, chap. 24, sec. 1), and the instru- 
 ment was not duly executed, and consequently not 
 entitled to probate, which was accordingly refused. 
 
 Besides disputes as to the validity of a will, the 
 question of the capacity of an aphasic person to manage 
 his own affairs may arise in a variety of ways. The 
 following case is a good illustration of the difficulty in 
 which loss of speech may sometimes place an individual 
 thus affected, and it is all the more interesting as it 
 formed the subject of a formal discussion in a scientific 
 body, perhaps the most competent in Europe to deal 
 with this question — La Societe de Medecine Legale de 
 Paris. 
 
 A merchant, aged 62, having acquired a fortune in his business, 
 was attacked with right hemiplegia and complete aphasia. After 
 some months of treatment, including a season at the baths of 
 Balaruc, he improved so as to be able to walk, although imperfectly ; 
 the arm, however, continued quite paralysed, and the aphasia 
 persisted. 
 
 Later on the paralysis in the arm yielded somewhat, but the 
 power of speech was limited to the sounds — O, o, a qui. Whatever 
 was said to him, he replied by these same syllables ; but he was 
 able to make himself understood by articulating these words with 
 different intonations, accompanied by very expressive signs executed 
 by the head or by the left hand. His wife, more accustomed than 
 others to his language, interpreted what he wished to say ; and if 
 she happened to convey a wrong notion of what he desired to say, 
 he showed great irritation, and endeavoured to make himself better 
 understood by more expressive gestures. As his right hand was 
 paralysed, he had learnt to write with the left hand ; but if left to 
 himself he could not write spontaneously, without copying — he 
 required a model under his eyes, and could only re-copy what was 
 written and set before him. 
 
TO MANAGE THEIR AFFAIRS GENERAELY. 307 
 
 In order to test the degree to which he had retained his intelli- 
 gence, it was pointed out to him that it would be to his advantage 
 to collect his rents every month, instead of allowing them to accu- 
 mulate for six months ; he indicated very clearly that he understood 
 this advice, and that he entirely approved it, and he informed his 
 wife that for the future he wished his rents to be collected in the 
 manner advised. 
 
 It was evident that in spite of his speechlessness, he had in a 
 great measure retained his intelligence and his power of volition, 
 and he knew perfectly well the state of his affairs. He frequented 
 places of public resort, and would pay for what he ordered without 
 making any mistake ; he was in the habit of seating himself near 
 those who were playing at cards, and he would intimate his 
 approval or disapproval of their playing, and even venture upon 
 advice, by means of signs ; he would play bezique himself without 
 committing blunders ; in fact, he kept up a sort of communication 
 with his neighbours by means of signs, which testified to the pre- 
 servation of his intelligence.' 5 
 
 The relatives of this gentleman had demanded what 
 the French law calls an " interdiction," and, after a pro- 
 longed discussion, the Societe de Medecine Legale 
 decided that his condition did not justify his being de- 
 prived of his civil rights ; and the Tribunal at Avignon, 
 to which the case was subsequently submitted, gave a 
 decision in conformity with the views of the Legal 
 Medical Society. 
 
 There cannot be a doubt about the propriety of the 
 above decision. This gentleman was the subject of 
 motor aphasia ; he was unable to express himself by 
 articulate language, but he possessed to an eminent 
 degree the language of signs. It will be observed that 
 he was also the subject of agraphia, for although he 
 
 * Annales d' Hygiene Publique et de Medecine Legale, tome. xxxi. 
 P- 43°. 
 
308 THE JURISPRUDENCE OF APHASIA IN CASES 
 
 could copy, he was unable to give spontaneous expres- 
 sion to his wishes by written language ; he could originate 
 nothing in writing, if his model were withdrawn he was 
 incapable of writing a single letter. 
 
 Of the numerous cases that I have recorded in the 
 earlier part of this treatise, as calculated to illustrate the 
 legal capacity of the aphasic, I would specify particularly 
 those of W. Sainty and R. Dalliston, whose clinical 
 symptoms fell under my own immediate observation, 
 and which are described in minute detail in the fourth 
 chapter (vide pp. ioo and 186). 
 
 It will be remembered that Sainty, the waterman, 
 after he was completely deprived of the power of speech, 
 took charge of his vessel, and removed it from one point 
 of the river to another ; on the following day he loaded it 
 with a fresh cargo, and then, unaccompanied by any of 
 his friends or comrades, took the train to his own home, a 
 distance of twenty miles. Although utterly speechless, 
 no doubt whatever could have been raised as to his 
 capacity to make a will or otherwise legally dispose of 
 his property. 
 
 The case of R. Dalliston is still more to the point, as 
 he lost the entire power of speech for six weeks ; but 
 although there was complete suspension of the faculty of 
 articulate language, the general faculty of language was 
 unimpaired, as he had retained the other media of 
 thought and of expression, being perfectly able to 
 describe all his symptoms in writing, as also by dactyl- 
 ology; for by means of the signs constituting the deaf 
 and dumb alphabet, he kept up a conversation with the 
 clinical assistant, who happened to understand and could 
 practise this means of communication. He could 
 
OF WORD-BLINDNESS AND WORD-DEAFNESS. 309 
 
 phonate ; there was no paralysis of the lips, facial 
 muscles, palate, or tongue ; these organs, for all pur- 
 poses except speech, were completely under control. 
 His intellect was clear, for the house surgeon informed 
 me that he passed his time in writing sermons ! He was 
 clearly in possession of the acoustic word-signs, and he 
 retained words in his memory as sensory images and as 
 symbols of thought, as shown by his capacity to translate 
 the same into writing, although he could no longer 
 enunciate them as a motor combination of articulate 
 sounds. The idea was present, the words were not 
 wanting, but articulation was not at the service of the 
 words ; in fact, his language was interfered with more 
 from its mechanical than from its intellectual side. Had 
 it been necessary, he was, of course, quite able to make 
 a will or execute any document whatever having 
 reference to the disposal of property. 
 
 In all the ceises that I have cited in this chapter, 
 the aphasia was of the motor type, being the result 
 of injury to the expressive mechanism of speech; but 
 when the patients are the subjects of Sensory Aphasia, 
 which is a disorder of the impressive mechanism of 
 speech — whether in the form of Word-deafness or of 
 Word-blindness — I can conceive that the gravest doubts 
 may arise as to how far they are able to make known 
 their wishes. 
 
 For instance, the word-deaf hears what is uttered in 
 his presence, but as there is an effacement of auditory 
 images, the words used fail to revive in his memory cor- 
 responding ideas. The history of Marie Bouquinet 
 (which I have given at page 220) is a good illustration of 
 the difficulties that surround word-deafness. In her case 
 
310 MEDICAL JURISPRUDENCE OF APHASIA. 
 
 there was " complete interruption in the association of 
 articulate sounds with acts of articulation and of things 
 signified." She could speak, read, and write, but there 
 was no revival of auditory impressions ; and she furnished 
 a typical instance of a psychical trouble, characterised by 
 an inability to understand spoken words, although the 
 organ of hearing itself was unaffected. 
 
 Likewise the word-blind, provided there were no 
 agraphia, would be able to write his instructions to his 
 lawyer ; but, to the astonishment of the latter, his client 
 would be unable to read what he himself had just 
 written. The case I have quoted from Professor 
 Charcot's lectures (vide p. 227) illustrates the difficulty a 
 word-blind would experience in satisfying his interlocutor 
 that he understood the purport of his instructions. It 
 will be remembered that in M. Charcot's patient there 
 was " interruption of the association formed between 
 written symbols and their equivalent articulations, and 
 with things signified." He had retained the power of 
 auditory reception, as well as that of verbal and graphic 
 transmission ; but he had lost all idea of the symbols of 
 written language from the receptive point of view — he 
 was able to write, but presented the singular phenomenon 
 of not being able to read his own handwriting. 
 
 It will, therefore, be seen that the study of Word- 
 deafness and of Word-blindness, so interesting to the 
 general physician, is of capital importance to the medical 
 jurist ; for without a knowledge of the pathology of these 
 singular affections, great injustice might accrue to those 
 affected with these forms of psychical disturbance. 
 
 The civil law in all countries has taken under its 
 protection those suffering from insanity, and has pro- 
 
MEDICAL JURISPRUDENCE OF APHASIA. 3 I I 
 
 mulgated measures not only to protect them from the 
 cupidity of others, but also from the effects of their own 
 delusions ; it, however, has not been found practicable 
 to frame a code applicable to those persons who are 
 simply deprived of the faculty of articulate language. 
 
 The legal codes in various states could not possibly 
 enter into all the details of cerebral pathology, for the 
 simple reason that at the time they were framed, the 
 science of psychology as applied to language, was in its 
 infancy; and even in the present day, when so much has 
 been done to elucidate the disorders of the brain and 
 nervous system, it is impossible to formulate any precise 
 rules, as to how far an individual deprived of the power 
 of speech is incapacitated for the full exercise and enjoy- 
 ment of his civil rights — each case must be determined 
 upon its own merits, and its own peculiar features. 
 
 It was formerly held that persons deaf and dumb from 
 their birth were, in contemplation of law, idiots, but this 
 presumption is no longer recognised ; if it can be shown 
 that such persons have the use of their understanding, 
 they are considered as amenable to the laws of the 
 country for their acts ;* they are allowed to marry, f and 
 
 * A prisoner, who was dumb, was charged with larceny ; it transpired 
 that he had been in the habit of conversing by means of signs, and a 
 woman was called who stated that the prisoner was capable of understand- 
 ing her by means of signs ; he was therefore arraigned, put upon his trial, 
 convicted, and received sentence of transportation. Roscoe — "Digest of 
 the Law of Evidence," 10th Edition, 1884, p. 117. 
 
 t At St. Lawrence Church, Norwich, on August 21st, 1871, Mr. 
 
 W. B was married to Miss G . Both parties were deaf and dumb, 
 
 as also were the two bridesmaids ! The service was conducted by the 
 Rev. A. Pownall, of Trowse, by means of the deaf and dumb alphabet ; 
 although performed with great rapidity, it was perfectly intelligible to the 
 parties concerned, though it was quite a "dead language" to those who 
 had assembled to witness the ceremony. 
 
312 LANGUAGE MAY BE NATURAL OR ARTIFICIAL; 
 
 are recognised as competent witnesses in courts of justice, 
 where they may be examined" through the medium of a 
 sworn interpreter who understands their signs.* 
 
 The mere fact of inability to speak will not absolve a 
 person from civil or criminal responsibility, whether the 
 defect be congenital as in the deaf-mute, or acquired as 
 in loss of speech from cerebral disease in after life ; such 
 persons, unless the contrary can be proved, are presumed 
 by law to be accountable for their actions. 
 
 There cannot be a doubt that in all the cases that I 
 have quoted as having been submitted to the judgment 
 of legal tribunals, the decisions have been logically- 
 correct, and quite in accordance with the dictates of 
 modern science. 
 
 As I have elsewhere stated, articulate language is by 
 no means the only medium of thought and expression,-f- 
 for as Maudsley observes, " Language consists essentially 
 in the establishment of a definite relation between the 
 
 * On one occasion the judge of the Lambeth County Court had to 
 decide a cause on the sole testimony of three deaf and dumb witnesses, 
 viz., the plaintiff and his wife on the one side, and the defendant on the 
 other. Taylor — "The Law of Evidence, 1 ' 1S72, Vol. ii., p. 1194. 
 
 f In an interesting chapter on possible modes of expressing thought, 
 Farrar says that all actual language addresses itself to the eye or to the ear ; 
 that art may be regarded as a language ; that in moments of extreme 
 passion, a language of gesture, appealing to the eye rather than to the ear, 
 is not only possible but extremely powerful, and one which will never be 
 entirely susperseded. Who, says he, that in modern days has seen a 
 Kemble or a Siddons, a Rachel or a Helen Faucit, can be ignorant of what 
 a language may be uttered by every motion and every look? Yet it is 
 probable that even the first of our modern actors falls short in this respect 
 of the skill of the ancient pantomimes, of whose ' loquacissimas manus, 
 linguosi digiti, silentium clamosum, expositio tacita,' Cassiodoius gives so 
 lively a description. Farrar — "Language and Languages," chap. vi. 
 
IT MAY BE VERBAL, VOCAL, GRAPHIC, OR MIMIC. 3 I 3 
 
 idea and the sign by which it is outwardly expressed ; 
 it may be verbal, vocal, graphic, or mimic. ... In 
 man the tongue has been almost exclusively appropriated 
 for the expression of thought, but there is no absolute 
 reason why his fingers, hands, and arms might not be 
 used, like the antennae of ants, and the hands and fingers 
 of the deaf-mute, to express all the results of mental 
 action."* 
 
 I have in a previous chapter gone so fully into the 
 distinction between natural and artificial language, that 
 I will not dwell upon it here, further than to say that the 
 General Faculty of Language was not abolished in any 
 of the cases I have quoted in this section ; for the sub- 
 jects of all of them retained the language of Gesture, 
 which, as before stated, is the natural language of the 
 deaf and dumb, and which is adopted amongst all 
 nations, when from ignorance of a foreign tongue, they 
 are obliged to communicate without an interpreter ; by 
 this form of language they were fully able to convey 
 to the minds of others what was passing in their 
 own.f Gesture language has been developed to such 
 an extent, that the services of religion are performed in 
 signs in many deaf and dumb schools ; and Tylor tells 
 us that in the Berlin Institution the simple Lutheran 
 
 * Maudsley— " The Physiology of Mind," pp. 475, 481. 
 
 + Mr. G. J. Romanes in his recent work on "Mental Evolution in 
 Man," has gone very fully into the question of gesture language :— 
 " Etymologically the word Language means sign-making by means of the 
 tongue, i.e. articulate speech. But in a wider sense, the word is habitually 
 used to designate sign-making in general, as when we speak of the ' finger- 
 language ' of the deaf and dumb. . . . Gesture language admits of 
 being developed to a degree which renders it a fair substitute for spoken 
 language, when the ideas to be conveyed are not highly abstract." 
 
3 H THE JURISPRUDENCE OF APHASIA. 
 
 service — a prayer, the gospel of the day, and a sermon — 
 is acted every Sunday morning in the gesture language, 
 for the children in the school, and also for the deaf-and- 
 dumb inhabitants of the city, constituting a very re- 
 markable sight. 
 
 Whilst engaged in writing this chapter, I have received 
 from America, a report of a meeting of " The Empire 
 State Association of Deaf-Mutes," held at Rochester, U.S., 
 on August 29th, 1888. At this Congress, the president's 
 opening address was delivered in signs, and it is stated 
 that his remarks met with a hearty response from his 
 deaf-mute audience, whose frequent applause testified to 
 its concurrence in the sentiments expressed. Can any- 
 thing be more conclusive than this touching incident, 
 as showing how Natural Language, can, when necessary, 
 replace Articulate Speech ? 
 
 That close observer of human nature, the great Italian 
 poet Dante, in his " Paradiso," has the following striking 
 passage on Natural Language: — 
 
 " Opera natural e e ch' uomo favella ; 
 Ma cosi, o cosi, natura lascia 
 Poi fare a voi secondo che v' abbella." 
 
 " It is a natural thing that man should speak ; 
 But whether this or that way, nature leaves 
 To your election, as it pleases you." 
 
 I have said enough to show that Aphasia does not 
 necessarily entail testamentary incompetency or inability 
 to discharge civil or social functions ; in fact, wills or 
 other legal documents should, as a rule, be recognised as 
 valid, when the parties concerned understand fully what 
 is put before them, and can express assent or dissent 
 with certainty, whether by articulate, written, or gesture 
 language. 
 
CHAPTER XI. 
 
 Summary— The Psychology of the ancients ; their crude notions of the 
 functions of the brain ; Hippocrates, Aristotle, Servetus, Descartes, Lapey- 
 ronie, Willis, and Huarte. The different theories as to the seat of speech ; 
 Gall, the pioneer of cerebral localisation; his system of Phrenology; the 
 value of his researches. A faculty should not be confounded with the 
 corporeal organ upon which its external manifestation depends. The 
 various theories of the localisation of the faculty of articulate language 
 considered, and weighed by the evidence contained in the preceding 
 chapters. 
 
 In the earlier chapters of this treatise, I entered into 
 the subject of the bibliography of aphasia, as illustrated 
 by the French, German, Dutch, British, and American 
 writers; a detailed account was then given of the clinical 
 history of cases that have fallen under my own immediate 
 observation ; I then described the different forms and 
 varieties in which loss or lesion of articulate language is 
 met with in practice ; whilst in the last chapter, I have 
 considered the subject in reference to the question of 
 Cause, Diagnosis, Prognosis, and Treatment. 
 
 We are now, therefore, in a position to criticise the 
 value of the different opinions which have been pro- 
 pounded as to the precise point of the cerebro-spinal 
 centre which is affected in aphasia, or in other words, to 
 consider whether there be a cerebral seat of speech at 
 all, and if so, where it is located ; and I now propose to 
 
3 16 THE PSYCHOLOGY OF THE ANCIENTS. 
 
 summarise, and carefully to weigh the evidence furnished 
 by the numerous cases recorded in the previous pages. 
 Leaving for the present the question of the existence or 
 non-existence of a speech centre, and assuming pro hdc 
 vice that there is one, I shall proceed at once to con- 
 sider the different theories which have been from time to 
 time promulgated as to the seat of articulate language. 
 
 The ancients seemed to have possessed the most crude 
 notions of the functions of the brain, as evidenced by 
 Hippocrates assigning the seat of the mind to the left 
 ventricle ; and by Aristotle also placing the sensorium 
 commune in the heart, the brain according to him, being 
 an inert viscus, serving no other purpose than to re- 
 frigerate the heart. Michael Servetus, who flourished in 
 the sixteenth century, and who seems to have been 
 endowed with a large measure of the imaginative faculty, 
 believed the choroid plexus was the organ destined to 
 secrete the animal spirits, that the fourth ventricle was 
 the seat of memory, and that the habitation of the soul 
 was in the aqueduct of Sylvius. A century later, Rene 
 Descartes, who so freely indulged in metaphysical and 
 transcendental speculations, assigned to the soul a more 
 secure position in the pineal gland * whilst Lapeyronie 
 placed it in the septum lucidum. 
 
 In later times, the brain has been universally con- 
 sidered to be the organ of thought and intelligence, but 
 
 * This prerogative of the pineal gland seems to have been a subject of 
 interest to the scientific world generally in the seventeenth century, for we 
 find our own countryman Willis, a contemporary of Descartes, in his 
 Anatomy of the Brain, stating that the pineal gland is not only found in 
 man and four-footed beasts, but that fowls and fishes also are endowed with 
 the same. " Wherefore, although from hence it may be concluded that this 
 is of necessary use, yet we can scarcely believe it to be the seat of the soul, 
 
gall's system of phrenology. 317 
 
 opinions have been and are still divided, as to whether it 
 is to be regarded as a single organ, or as consisting of a 
 series of distinct organs, each endowed with a special 
 and independent function — whether, in fact, the phe- 
 nomena of intelligence are due to an action of the brain 
 as a whole, or whether the different psychological 
 elements which constitute them are connected with 
 isolated and circumscribed parts of the encephalon.* 
 
 Out of the last theory has arisen the principle of the 
 localisation of the cerebral faculties, which was first 
 announced in a definite form by Gall, who divided the 
 encephalon into organs endowed with primordial faculties, 
 distinct the one from the others. The germ of this idea 
 of the polysection of the encephalon is to be found in 
 the writings of physiologists long before the time of 
 Gail ; indeed, one writer, Charles Bonnet, assigned a 
 special function to each fibre ; stating that every faculty, 
 sensitive, moral, or intellectual, was in the brain con- 
 nected to a bundle of fibres, that every faculty had its 
 own laws which subordinated it to other faculties and 
 determined its mode of action, and that not only had 
 every faculty its fasciculus of fibres, but that every word 
 had its own fibre !f 
 
 or its chief faculties to arise from it ; because animals which seem to be 
 almost destitute of imagination, memory, and other superior powers of the 
 soul, have this gland large and fair enough." — Willis. Cerebri Anat., 
 cap. xiv., p. 102. 
 
 * Those who may desire more detailed information as to the various 
 theories of the seat of speech which were in vogue before the time of Gall, 
 I would refer to an extremely interesting series of papers published by the 
 late Dr, Hunt in the "Anthropological Review." 
 
 + A Spaniard, Jean Huarte, who lived in the sixteenth century, pub- 
 lished a work on the diversity of aptitudes, intellectual and instinctive, and 
 he proposed that a jury of scientists should determine what course of 
 
3 1 8 gall's system based on the external 
 
 Iii more recent times, some physiologists have carried 
 their localising tendencies so far as to assert, that certain 
 ultimate microscopic elements of the grey matter of the 
 brain (ganglionic cells) are endowed with a distinct 
 psychological function; and a writer, in commenting 
 upon the number and precise arrangement of the cere- 
 bral elements, conjectures that there may be, in the 
 higher cerebral centres, something like one thousand 
 million corpuscles, and five thousand million fibres ; and 
 that thus for each nervous grouping of a certain com- 
 plexity, there would be from five to twenty thousand 
 cells, and from twenty-five to one hundred thousand 
 fibres.* 
 
 The circumstance which directed Gall's attention to 
 the possibility of connecting the brain with certain 
 faculties of our mental nature is so well known that I 
 scarcely need allude to it. In his early days, he often 
 found himself surpassed by certain of his fellow students 
 who he felt were intellectually inferior to himself, but 
 in whom a remarkable memory coincided with a striking 
 prominence of the ocular globes. This external promi- 
 nence led him to the inference that there was an 
 internal cerebral prominence which produced it, and it 
 was the application of this reasoning to other cranial 
 protuberances that gave rise to his craniological doctrine. 
 According to Gall, the brain is composed of various 
 parts, to each of which a special function belongs, and 
 his system embraces the topographical determination of 
 each of these organs. The organs of the memory of 
 
 study should be assigned to each child, and what career should be selected 
 for each adolescent. He does not seem, however, to have founded his 
 theory upon any cranioscopic investigations. 
 
 * "Mind and Body." By Alexander Bain, LL D, 1873. 
 
PROMINENCES OF THE SKULL; CRANIOSCOPY. 319 
 
 words, of the memory of persons, and of the faculty of 
 language, he located in the convolutions which rest on 
 the floor of the orbit, and which form the inferior sur- 
 face of the anterior lobe ; the organ of the memory of 
 persons he placed immediately above the inner angle of 
 the orbit, that of the memory words in the convolution 
 which rests on the posterior half of the roof of the 
 orbit, whilst the organ of language or speech he placed 
 in the convolution which rests on the anterior half of 
 the orbital roof, in front of the preceding faculty. 
 
 The minute anatomy of the convolutions was un- 
 known in the time of Gall, and he based his phrenologi- 
 cal theories rather on the external prominences of the 
 skull — on cranioscopy — than upon a careful study of the 
 convolutions to which these prominences corresponded, 
 and although his conclusions must be considered in 
 many instances arbitrary and hypothetical, still I would 
 say, "Let not the spark be lost in the flame it has 
 served to kindle," for in spite of all that has been said 
 against Gall, and all that has been written in deprecia- 
 tion of his labours, beyond all doubt his researches gave 
 an impulse to the cerebral localisation of our faculties, 
 the effect of which is especially visible in our own days ; 
 and I look upon his work as a vast storehouse of know- 
 ledge, and as an imperishable monument to the genius 
 and industry of one of the greatest philosophers of the 
 present age. The localisation of cerebral function may 
 be said to have received the first real impetus from Gall, 
 for before his time no such attention was given to the 
 subject as deserved the name of systematic study. 
 
 Gall's labours would undoubtedly have met with a 
 more hearty recognition from his contemporaries, had 
 not the Austrian priesthood raised the cry of " material- 
 
 X 
 
320 THE FACULTY MUST NOT BE CONFOUNDED 
 
 ism" as applied to his doctrines.* In defending himself 
 from this charge, and with the view of explaining that 
 the plurality of the cerebral organs is not opposed to the 
 unity of the Ego, Gall thus expresses himself: — 'When 
 I say that the exercise of our moral and intellectual 
 faculties depends upon material conditions, I do not 
 mean to imply that our faculties are a product of the 
 organism ; this would be confounding conditions with 
 efficient causes' The great German psychologist had no 
 such heterodox notions as his adversaries maliciously 
 attributed to him, for, to use the language of Hufeland, 
 'he was employed in analysing the dust of the earth 
 of which man is formed, not the breath of life which was 
 breathed into his nostrils ; ' or, as Froude philosophically 
 remarks, ' It is nothing to me how my Maker has been 
 pleased to construct the organised substance which I 
 call my body. It is mine, but it is not I.' 
 
 In my treatise on " Darwinism tested by Language," I 
 have entered at considerable length into the question of 
 the mysterious connection between Matter and Mind, 
 and I shall not dwell upon it here further than to re- 
 
 * As in Gall's days so in ours, this very indefinite and unmeaning word 
 " materialism " is used as a kind of psychological scare-crow to frighten all 
 those who are endeavouring to trace the connection between matter and 
 mind. Surely there is nothing contrary to sound theology in assigning 
 certain attributes or functions of an intellectual order to certain parts of 
 our nervous centre ; the cerebral localisation of our divers faculties, and the 
 plurality of our cerebral organs, stiike no blow at the great principle of the 
 moral unity of man. The same power that caused the earth 'like a spark 
 from the incandescent mass of unformed matter, hammered from the anvil 
 of omnipotence, to be smitten off into space,' this same power, surely, 
 could just as well ordain that a multiplicity of organs should be necessary 
 to the full development of man's mental faculties, as that the manifestation 
 of them should depend upon the integrity of one single organ. 
 
WITH ITS CORPOREAL ORGAN. 32 1 
 
 mark, that the material condition which renders the 
 exercise of a faculty possible is the existence of an 
 organ; but it is important not to confound the faculty 
 itself with the corporeal organ upon which the external 
 manifestation of this faculty depends. 
 
 Gall's conclusions were based purely on the study 
 of anatomy, but subsequent observers — Bouillaud, 
 Schrceder Van Der Kolk, Broca, and others — have 
 brought the light of pathological observation to shine 
 upon this obscure subject ; and, with the view of testing 
 the soundness of the respective theories advanced by 
 these physiologists, I propose briefly to weigh the 
 evidence which has been furnished for or against the 
 various theories which have, in modern times, been pro- 
 mulgated as to the seat of speech, and to endeavour to 
 guide my readers through this labyrinth of contra- 
 dictory affirmations. Here, however, I would observe, 
 that this question will never be settled by mere theo- 
 retical speculation, without the aid of that inexorable 
 scrutiniser of facts — necroscopic examination ; moreover, 
 the scientific facts must be accepted as they are found, 
 without any attempt to make them fit in with precon- 
 ceived ideas. It is in the above spirit that I propose to 
 try and ascertain how far the evidence contained in the 
 preceding chapters is calculated to support any of the 
 promulgated theories as to the seat of articulate lan- 
 guage. 
 
 I will first discuss the theory which has perhaps found 
 the fewest advocates — that of Schroeder Van Der 
 Kolk — who placed the seat of speech in the corpora 
 olivaria, which he believed were connected with each other 
 and with the facial and hypoglossal nuclei by com- 
 
322 ON THE LOCALISATION OF THE FACULTY 
 
 missural fibres. This doctrine has lately found a warm 
 supporter in M. Jaccoud, who thus expresses himself in 
 reference to it ; — " The functional centre of the articula- 
 tion of sounds and of deglutition is situated in the 
 medulla oblongata. It is constituted respectively by 
 the union of the hypoglossal, the facial, the glosso- 
 pharyngeal, the spinal accessory, and the trifacial nerves. 
 For the isolated movements of the tongue, of the lips, 
 of the cheeks, of the velum palati, and of the pharynx, 
 each of these nerves acts independently in its sphere of 
 distribution ; but for the complex and simultaneous 
 movements which are necessary for the production of 
 articulate sounds and of deglutition, all the original 
 nuclei of these nerves are connected together, also the 
 one side with the other, by the olivary system, which 
 thus becomes the co-ordinating organ of the final 
 functional act."* 
 
 Kussmaul says that this hypothesis must be definitely 
 abandoned ; that neither Deiters nor Meynert have been 
 able to find any commissural fibres; and that the 
 evidence furnished by comparative anatomy is directly 
 opposed to this theory. The parrot and other animals 
 capable of imitating and mimicking articulate speech 
 possess no olivary bodies, or possess them only in a 
 rudimentary form ; while the seal, whose reputation for 
 eloquence has not yet been established, has these bodies 
 of enormous size.f 
 
 M. Vulpian also criticises most severely Van der 
 Kolk's conclusions, and quotes .a case observed by 
 himself, where, although the olivary bodies were both 
 
 * Gazette Hebdomadaire de Medecine et de Chirurgie, July 22, 1864. 
 f Die Storune;en der Sprache, cap. xviii., s. 67. 
 
OF SPEECH IN THE OLIVARY BODIES. 323 
 
 manifestly diseased, yet speech remained perfectly un- 
 impaired to the last* 
 
 Of the numerous cases to which I have called atten- 
 tion in the preceding pages, I find that in five only the 
 olivary bodies were stated as having been found diseased 
 after death. The first three cases are quoted by Van 
 Der Kolk. In one of these, in addition to atrophy of 
 the olivary bodies, there was an extremely imperfect 
 development of the frontal convolutions, and also a 
 positively diseased condition of the anterior lobes ; in 
 another case, although there was found grey degeneration 
 of the right olivary body, there was also disease of other 
 parts, namely, in the crura cerebri, the corpus callosum, 
 one of the thalami, the fornix, and the corpora pyrami- 
 dalia ; in the third case I have quoted from Van Der 
 Kolk, as well as in one from Abercrombie, in addition 
 to the disease in the corpora olivaria, there was also 
 disease in one of the crura cerebelli and in the tubercula 
 mamillaria ; and, lastly, in a case observed by Romberg, 
 the affection of the corpus olivare coincided with disease 
 in the right half of the pons Varolii. It must, therefore, 
 be conceded, that as in all these, in addition to a diseased 
 state of the olivary bodies, there was extensive disease 
 in other parts, they cannot be looked upon as sub- 
 stantial evidence in favour of the localisation of speech 
 in the corpora olivaria; in fact, Cruveilhier, who was the 
 author of all the observations which I have quoted from 
 Van Der Kolk's work, was quite innocent himself of 
 drawing from them any inference as to the connection 
 of the olivary bodies with the articulation of words. 
 
 * Le?ons sur la Physiologie generate et comparee du Systeme Nerveux, 
 P- 495- 
 
324 SEAT OF SrEECH IN THE OLIVARY BODIES. 
 
 In one of the most important contributions to the 
 anatomy of the medulla oblongata published in this 
 country, its author, Dr. Lockhart Clarke, mentions two 
 cases of aphasia, in each of which one of the olivary 
 bodies was diseased ; being in the one case atrophied, 
 and in the other the seat of a former clot. In both these 
 instances there were numerous and extensive lesions in 
 other parts of the brain, therefore — as Dr. Clarke also 
 admits — they by no means prove that the loss of speech 
 was due to the diseased condition of the olivary bodies. 
 Elsewhere he says, ' whether or not the olivary bodies be 
 subservient to the operations of speech and deglutition, 
 it is quite certain that these are not their only functions. 
 We have seen that in all the mammalia except the mute 
 porpoise, they are very much smaller than in the monkey, 
 who is wholly unable to articulate, and in whom the 
 act of deglutition has nothing peculiar. But even if it 
 should be imagined by some that the chattering of the 
 monkey is a kind of speech, the ourang outang and the 
 chimpanzee are not more gifted in this respect than the 
 inferior tribes, yet their olivary bodies are much more 
 highly developed. Now, except the superior intelligence, 
 the only endowments that distinguish the ape-tribe from 
 all other mammalia, are their singular faculty of imita- 
 tion and gesticulation, and their power of expressing 
 a variety of emotions, of which they are very suscep- 
 tible.'* 
 
 Of late years, much attention has been given to the 
 physiology of the Pons Varolii, and a great deal has 
 
 * "Researches on the Intimate Structure of the Brain." Philosophical 
 Transactions 1868, Pt. I., p. 312. 
 
THE TONS VAROLII THEORY. 325 
 
 been written about its functions ; and some physiologists 
 have attempted to locate speech in that organ. 
 
 Dr. Allen Starr, of New York, has published minute 
 details of the clinical history of 23 cases of disease of 
 the pons, verified by post-mortem examinations, and in 
 none of these was there what could be called aphasia, 
 although in some instances, the speech is mentioned as 
 being impaired in some way or other, deglutition being 
 affected also. In one case of softening of the pons, it 
 is stated that speech became unintelligible as the facial 
 paralysis increased ; the tongue also became partly 
 paralysed, and before death could hardly be protruded. 
 In another case, where there was haemorrhage into the 
 pons, the speech was slow, jerky, and drawling, but 
 there was no aphasia.* 
 
 I have thought it right to make a passing allusion to 
 the Pons theory, rather as a matter of literary curiosity, 
 for it has not received any general support, and doubtless 
 the disturbance of speech observed in disease of the 
 pons is due to faulty innervation of the apparatus of 
 phonation.f 
 
 The next theory for consideration is that of M. Bouil- 
 laud, who placed the seat of speech in the anterior lobes, 
 
 # (( 
 
 'The Sensory Tracts in the Central Nervous System." Journal of 
 Nervous and Mental Disease, July, 1884, pp. 357 — 377- 
 
 t In an original and very remarkable essay, entitled " The Brain not the 
 Sole Organ of the Mind," another American writer, Dr. Hammond, men- 
 tions certain curious facts which have an indirect bearing upon this subject. 
 He quotes a case of an anencephalic child, who was able to cry, although 
 there was not a vestige of cerebrum. He contends that the mental faculties 
 of perception and volition are seated in the spinal cord, as well as in the 
 cerebral ganglia; and he cites numerous experiments in support of the 
 inference, that mental power must be conceded to the spinal cord, and that 
 the brain can no longer be considered as the sole organ of the mind. 
 
326 LOCALISATION OF THE FACULTY OF SPEECH. 
 
 and who, twenty years ago, offered a prize of 500 francs 
 for any well authenticated case negativing his views. 
 Although this theory has met with less opposition than 
 the others, several cases have been recorded which, to 
 say the least, throw considerable doubt upon its truth. 
 Let us see what evidence the previous pages of this 
 treatise furnish for or against the views of M. Bouillaud, 
 who, it must be remembered, admitted that speech may 
 exist with one frontal lobe destroyed, but who maintained 
 that when both are destroyed or seriously damaged, 
 articulate language becomes impossible. 
 
 I have quoted three cases* in which both anterior 
 lobes were destroyed or very extensively injured. What 
 does a conscientious analysis of them teach us ? In 
 M. Peter's case we have seen that speech was preserved, 
 although both frontal lobes were reduced to a pulp 
 (reduits en bouillie) ; in one of M. Trousseau's cases, a 
 ball had traversed the two frontal lobes at their centre, 
 entering at one temple and making its exit by the 
 other, articulation remaining unimpaired during the six 
 months the patient survived this fearful injury; in 
 M. Velpeau's celebrated case a scirrhous tumour had 
 taken the place of the two anterior lobes, but instead of 
 being speechless the man was remarkably loquacious.! 
 
 * Vide pp. 28 and 32. 
 
 f It is well known that tumours of the brain, by their slow and gradual 
 development, frequently compress, deform, and displace the cerebral tissue, 
 without sensibly altering the function of that organ ; and it has been 
 suggested, that in these cases there may be a sort of unfolding of the brain 
 tissue by the pressure of the tumour which has developed itself in its place, 
 but not at the expense of the tissue itself, which, in its new relations, and 
 under the form and volume to which it has been reduced, may still retain 
 the integrity of its structure, and its habitual functional aptitude. A good 
 illustration of this capacity of the brain to adapt itself to altered circum- 
 
SEAT OF SPEECH IN THE ANTERIOR LOBES. 327 
 
 These three cases, to which I could add others, seem 
 to upset M. Bouillaud's doctrine by showing that a 
 profound lesion may exist in both anterior lobes, with- 
 out impairment of articulate language ; but on the 
 other hand, it is only fair to observe that in none of 
 them was there positive evidence of the complete 
 destruction of the anterior lobes, for in M. Peter's case, 
 although the lesion must have been extensive, still, as 
 the words " comes frontdles" are used to describe the 
 part injured, the posterior part of the same lobes may 
 possibly have remained unaffected ; again, in M. 
 Trousseau's case it is possible to conceive that the 
 transit of a ball through both anterior lobes may have 
 left a portion of the cerebral substance uninjured ; in 
 reference to M. Velpeau's barber, in reading carefully 
 the details of the autopsy as noted in the Bulletins de 
 l'Academie de Medecine, I find it stated that a portion 
 of the right anterior lobe was not involved in the 
 tumour, also - that at the posterior, external, and inferior 
 part of the left lobe, there was a certain thickness of 
 cerebral substance unimpaired. 
 
 The adversaries of the localisation of speech in the 
 anterior lobes have attached an immense importance 
 to a case mentioned by Cruveilhier of a congenital 
 idiot, who could pronounce words distinctly articulated, 
 although after death it was found that there was 
 congenital absence of the two anterior lobes. This ob- 
 
 stances is furnished by Mr. Cadge's case which I have quoted at page 41, 
 where a tnmour of the size of a hen's egg had invaded a portion of the left; 
 anterior lobe, without giving rise to aphasia. I need scarcely add, that 
 this explanation cannot apply to the cases I have quoted, in which integrity 
 of speech coincided with tumours involving nearly the entire anterior 
 lobe. 
 
328 LOCALISATION OF THE FACULTY OF SPEECH. 
 
 servation has such an important bearing upon our 
 present inquiry, that an abridgment of it must find a 
 place here. 
 
 Alexandrine Vaillosge, a congenital idiot, came under observation 
 at the age of twelve — the idiocy being carried to the highest 
 degree. She could neither dress nor feed herself; although she 
 could move her limbs in all directions, she was unable to co-ordin- 
 ate her movements for the act of walking, and it was necessary to 
 carry her from place to place. The sense of smell seemed not to 
 exist, or rather the young idiot was insensible to bad odours ; the 
 other senses presented nothing remarkable. If one threatened to 
 strike her she would make the most frightful noises. The desire 
 for food was readily felt, and when hungry she would express 
 her wants by means of words very distinctly articulated. This 
 girl having died at the age of fifteen of chronic diarrhoea, the 
 following post-mortem appearances were observed : — The skull 
 was very well formed exteriorly, but its cavity was not completely 
 filled by the brain. The anterior lobes were entirely absent, and 
 a limpid serum contained in the cavity of the arachnoid occupied 
 the space which separated the anterior extremity of the brain from 
 the frontal portion of the dura mater. Strange to say, the orbital 
 plates, although not in contact with the brain but with serum, 
 presented the mammillary eminences and digital impressions ex- 
 actly similar to those of a healthy individual of the same age. 
 With the exception of the absence of the anterior lobe, the left * 
 hemisphere completely filled the corresponding part of the skull ; 
 the right hemisphere, the size of which was only about half that of 
 the left, was separated from the parietes of the skull by a space 
 filled with serum.* 
 
 Cruveilhier himself seems to have considered this case 
 as fatal to the doctrine of the localisation of speech in 
 the anterior lobes ; on examining, however, carefully 
 the beautiful plate annexed to the description of it, 
 it is evident that when the author stated that the two 
 anterior lobes were wanting, he did not limit these lobes 
 
 * Cruveilhier, Anatomie Pathologique, 8e Livraison, pi. 6. 
 
SEAT OF SPEECH IN THE ANTERIOR LOBES. 329 
 
 ill the same way that we do now. For Cruveilhier, the 
 anterior lobes were limited inferiorly to that part of the 
 hemisphere which lies on the root of the orbit,* for a 
 glance at the plate will show that only the anterior half 
 of the left frontal lobe was destroyed, the transverse 
 frontal convolution being preserved, as well as the posterior 
 half of the 1st, 2nd, and 3rd frontal convolutions ; al- 
 though the disease in the right hemisphere was more 
 extensive, the plate shows that a considerable portion 
 of it still remained. According, therefore, to our present 
 mode of dividing the brain, this case cannot be cited as 
 impugning M. Bouillaud's theory. 
 
 An observation has been published by M. Aubertin, 
 which at first sight might seem to lend a powerful 
 support to M. Bouillaud's theory. 
 
 A man was one day brought to the hospital Saint Louis, who 
 with the view of committing suicide, discharged the contents of a 
 pistol into his forehead. On examination, it was found that the 
 frontal bone was completely shot away ; the anterior lobes were 
 exposed, but not injured. Intelligence was unaffected, and speech 
 was perfect. As the patient survived several hours, the opportunity 
 was taken to make the following experiment upon him. Whilst he 
 was talking, a large spatula was applied horizontally to the two 
 anterior lobes, which it lightly compressed ; speech was instantly 
 suspended — le mot commence etait coupe en deux ; the power of 
 speech returned the moment the pressure was removed. It is 
 further added that the pressure was made with so much care, that 
 the general functions of the brain were in nowise affected by the 
 experiment ; the only faculty suspended was that of articulate 
 language.f 
 
 * This limitation of the anterior lobe is correct only as far as the orbital 
 convolutions are concerned, for a glance at the plate facing the title page 
 of this treatise, v/ill show that above the orbital portion, the anterior lobe 
 extends very much further backwards. 
 
 t Gazette hebdomadaire, 1863, p. 351. 
 
330 LOCALISATION OF THE FACULTY OF SPEECH. 
 
 The above experiment, although of great scientific 
 interest, can scarcely be said to prove the localisation of 
 speech in the anterior lobes ; for pressure made on the 
 denuded surface of these lobes must necessarily have 
 been transmitted to other parts of the brain. 
 
 I now pass to the consideration of the theory of 
 M. Dax. The brain as a whole has hitherto been con- 
 sidered as a symmetrical organ, even by those who 
 regarded it as an assemblage of lesser organs arranged 
 in pairs 'with corresponding functions ; M. Dax, how- 
 ever, assigns a function to the left hemisphere, which, 
 according to him, is not shared by the right ; for he 
 places the lesion in aphasia solely in the left hemisphere, 
 without however limiting it to any part of that hemis- 
 phere.* 
 
 This is a question that can only be settled by a 
 careful statistical research. M. Broca estimated the 
 proportion of aphasics with lesion in the right hemis- 
 phere as i in 20. In 1864, M. Vulpian tabulated all the 
 cases bearing upon this question which came under 
 his observation, at La Salpetriere. They were twelve 
 in number, and divided as follows : — Lesions of the left 
 anterior lobe with aphasia, 5 5 lesions of the left anterior 
 lobe without aphasia, 4 ; lesions of the right anterior 
 
 * Dr. Dax's conclusions were embodied in a communication to the 
 medical congress held at Montpellier in the year 1836, the title of his 
 paper being — Lesions de la moitie gauche de l'encephale coincidant avec 
 l'oubli des signes de la pensee. In 1S63 his son, Dr. G. Dax, presented 
 a memoir to the Academy of Medicine of Paris, in which, whilst supporting 
 the views of his father as to the seat of speech in the left hemisphere, he 
 confined it to more narrow limits, namely, the anterior and external part 
 of the middle lobe. 
 
SEAT OF SPEECH IN THE LEFT ANTERIOR LOBE. 33 I 
 
 lobe without aphasia, 1 ; cases of aphasia without lesion 
 of either anterior lobe, 2. It will be remembered that 
 M. Dax's paper contained 140 observations confirmatory 
 of his view. Notwithstanding numerous and well- 
 authenticated exceptions, it must be conceded that in a 
 vast majority of instances, loss of speech occurs in con- 
 junction with right hemiplegia, a coincidence which may 
 perhaps be explained on physiological gounds, as we 
 shall see presently. 
 
 Dr. Dax's theory receives valuable support from such 
 cases as that I have quoted as occurring in the Middlesex 
 Hospital under Dr. Stewart, where the patient retained 
 the power of speech after an attack of left hemiplegia, 
 but became aphasic a few days later, on the occurrence 
 of dextral paralysis. An analogous case has recently 
 been published by M. Auguste Voisin, the leading 
 features of which deserve a passing allusion, not only 
 from its clinical importance, but from the scrupulous 
 care with which the autopsy is described. 
 
 A female, aged 55, was under the care of M. Voisin, at La Sal- 
 petriere, for left hemiplegia of four years' duration ; speech, as 
 well as the intellectual powers, being unimpaired. One day she 
 was suddenly seized with giddiness, followed by complete aphasia ; 
 at the expiration of four days, the report states that there was no 
 recovery of speech, but that the patient made herself understood 
 by gesture. On the fifth day death ensued. Autopsy — The mem- 
 branes are normal in appearance, and are easily removed without 
 injury to the grey substance beneath. A large number of vessels 
 contain calcareous plates. In the right hemisphere, the 1st, 2nd, 
 and 3rd frontal convolutions are perfectly healthy, as also the 
 island of Reil ; on opening the lateral ventricle from above, a 
 pulpy softening is noticed of a pale yellow colour occupying the 
 corpus striatum, without, however, involving its extra-ventricular 
 nucleus, or extending to the grey and white substance adjoining 
 the insula. In the left hemisphere, the 1st, 2nd, and 3rd frontal 
 
332 LOCALISATION OF THE FACULTY OF SPEECH. 
 
 convolutions present no alteration, but not so the island of Reil, in 
 which there is a very superficial and circumscribed softening (de 
 8 ou 10 millimetres de diametre), limited to the grey matter ; the 
 subjacent white matter, as well as the extra-ventricular nucleus of 
 the left corpus striatum, being perfectly free from disease of any 
 kind. The neighbouring vessels are more or less infiltrated with 
 calcareous salts, and an artery of medium calibre, destined for the 
 nutrition of the island of Reil, is entirely obstructed by a calcareous 
 deposit. Several portions having been submitted to microscopic 
 examination, the following appearances were observed; i° A large 
 number of corpuscles of Gluge of a reddish yellow colour ; 2" some 
 crystals of hematoidine disseminated here and there, also of a 
 decidedly reddish yellow colour ; 3 a considerable number of oil 
 globules ; 4 very irregular nerve-tubes ; 5 = blood vessels com- 
 pletely discoloured, and presenting some isolated colourless 
 corpuscles.* 
 
 M. Voisin calls attention to the fact that the interest 
 of the above case consists in the limitation of the lesion 
 to the grey matter of the left island of Reil, also to the 
 complete aphasia occurring in a woman, who, for four 
 years, had been hemiplegic on the left side from soften- 
 ing of the right corpus striatum ; he also observes that 
 if his attention had not been called to the loss of speech, 
 such a circumscribed lesion might well have escaped his 
 notice ; in which case, this necropsy would have swelled 
 the number of those where no anatomical lesion could 
 be found to explain the aphasia. 
 
 Thus the arguments in favour of M. Dax may be said 
 to be of a positive and of a negative kind, and could we 
 stop here, M. Dax's position might be said to be im- 
 pregnable ; but — audi alteram partem — there is another 
 side to the picture, and the partisans of M. Dax must 
 explain away certain exceptional cases, which it seems 
 difficult to reconcile with the truth of his views. 
 
 * Gazette des Hopitaux, Jan. 25th, 1868. 
 
SLAT OF SPEECH IN THE LEFT ANTERIOR LOBE. 333 
 
 Several instances have been recorded in which serious 
 disorganisation of the left anterior lobe coincided with 
 perfect integrity of speech. I have already quoted such 
 cases, and I can make but a cursory allusion to some 
 others that have been brought under my notice. 
 
 M. Maximin Legrand has related the history of a man 
 who was shot in the head during the Revolution of 1848, 
 and whose speech was not in the least affected, although 
 after death it was found that the left anterior lobe had 
 been shattered by the discharge from a gun.* M. 
 Beclard has published the case of a syphilitic patient 
 whose speech remained unaffected to the last, although 
 it was found that all the left hemisphere was reduced 
 to a pulp.f One of the most uncompromising opponents 
 of M . Dax's views is M. Lelut, whose report on M. Dax's 
 paper gave rise to the prolonged discussion on this 
 subject at the Academy of Medicine of Paris. After 
 inveighing in general terms against all cerebral localisa- 
 tion, M. Lelut reminded the academy of a case he had 
 published thirty years ago, of an epileptic who retained 
 his speech in its integrity to the last moment, although 
 his entire left hemisphere was completely disorganised. J 
 
 * Dictionnaire Encyclopedique des Sciences Medicales, Article "Aphasie," 
 par Jules Falret, p. 628. 
 
 + Ibid, p. 628. 
 
 J I give the leading features of this case in M. Lelut's own words. It 
 affords another illustration of the manner in which cases are distorted to 
 suit particular theories, for on referring to the original description as it 
 appeared in the Journal Hebdomadaire de Medecine, it seems that instead 
 of complete disorganisation of the left hemisphere, the lesion was limited 
 to the posterior and middle lobes, and the report goes on to say that "the 
 anterior lobes were very well developed, and their convolutions had the 
 usual proportions." In reference to the question we are now con- 
 sidering, this is, doubtless, not the only instance in which a clinical obser- 
 
334 EXPERIMENTS IN HYPNOTISM. 
 
 As a sort of counter-proof of his anti-localisation views, 
 he mentioned the case of a carcinomatous disease of the 
 cerebellum with aphasia, where the left hemisphere of 
 the brain was quite healthy. 
 
 There is also another class of observations which seem 
 to me to be irreconcilable with the exclusiveness of 
 M. Dax's unilateral theory, for there exists a certain 
 number of carefully recorded cases, in which aphasia was 
 one of the symptoms, although the lesion was limited to 
 the right hemisphere. I have already cited instances of 
 this kind ; and quite recently Dr. Spender, of Bath, has 
 published an interesting case of idiopathic abscess in the 
 right hemisphere, in which during life the symptoms 
 were epileptic convulsions in the left arm and leg, and 
 subsequently loss of speech and left hemiplegia. 
 
 This seems to be the proper place to consider the 
 remarkable experiments of M. Charcot, at La Salpetriere, 
 which have an indirect bearing upon the theory of 
 M. Dax — in fact, they have been quoted as furnishing an 
 additional proof of the localisation of speech in the left 
 anterior lobe ; and here I would remark that it is cheer- 
 ing to find that by the influence of Charcot and Richet 
 in Paris, Bernheim and Beaunis at Nancy, and Hack 
 Tuke in this country, men of science are turning their 
 attention to the study of hypnotic phenomena, instead 
 of leaving them to charlatans and unscientific observers. 
 
 As the result of M. Charcot's experiments in hypno- 
 tism, two conditions have been described, called respect- 
 
 vation has been misinterpreted according to the fancy of individual critics. 
 M. Lelut has chosen to cite it as militating against Dax's theory ; surely 
 Bouillaud and Broca have a better right to claim it as pre-eminently tending 
 to support their views. 
 
EXPERIMENTS AT LA SALPETRIERE. 335 
 
 tively " Hysterical Lethargy," and the " Cataleptic 
 State." It is reported that most cases of grave hysteria, 
 can be thrown into the first of these two conditions by 
 directing the eyes to be fixed steadily on some point — 
 the tip of a penholder held in the hand, for instance; in 
 a few moments, the head inclines to the right or to the 
 left, the eyelids close, the limbs become motionless 
 and limp, the tendon reflexes are greatly exaggerated, 
 and there is a marked neuromuscular hyperexcitability, 
 a phenomenon first observed by M. Charcot, and 
 which he designated hyperexcitabilite nenromusculaire dcs 
 liypnotiques, and which consists of the aptitudes which 
 voluntary muscles acquire to contract under the irritation 
 of simple mechanical irritation ; the power of speaking, 
 however, remains. This is the condition of hysterical 
 lethargy. 
 
 It is easy to cause the patient to pass from the hypnotic 
 condition to the cataleptic stage. All that is required is 
 to open the eyelids and allow the retinae to be stimulated 
 by the rays of light ; the patient immediately becomes 
 cataleptic, but a remarkable difference is observed 
 between the two sides, as shown by the following ex- 
 periment made by M. Lepine, one of M. Charcot's 
 assistants. 
 
 A female patient is hypnotised ; if asked to speak, write, or make 
 any gesture, whilst in this condition, she obeys. The left eyelid is 
 then opened and the left retina stimulated, thus plunging the right 
 hemisphere into a state of catalepsy ; there is no change from a 
 linguistic point of view, the patient continues to speak, to write, 
 and to gesticulate. The process is modified ; the left eyelid is 
 closed and the right opened with corresponding stimulation of the 
 right retina, thus plunging the left hemisphere into a state of 
 catalepsy; immediately all communication with the external world 
 is suppressed, the patient can neither speak, write, nor gesticulate. 
 
 Y 
 
33& HYPNOTIC EXPERIMENTS AND THEIR 
 
 " Le masque facial reste muet." A moment before, when the right 
 hemisphere was in a cataleptic condition, every form of language 
 subsisted ; now that a similar condition is induced in the left 
 hemisphere, language of every kind is abolished. 
 
 The above experiment was repeated in the case of another 
 patient who knew by heart some pieces of poetry. Whilst in the 
 hypnotic state, she repeated certain verses distinctly. The left 
 eyelid was raised, but she continued her recitation ; but on the left 
 lid being closed and the right opened, thus producing catalepsy 
 in the left hemisphere, she straightway ceased to speak in the 
 middle of averse, sometimes even in the middle of a word. On 
 closing the right eyelid, she began her recitation again, at the very 
 place at which she left off, recommencing sometimes in the middle 
 of a word !° 
 
 M. Ballet in commenting upon the above curious 
 phenomena, lays great stress upon their value as ex- 
 periments in vivo, tending to confirm the results of 
 clinical, observation, which would place the seat of 
 speech in the left anterior lobe to the exclusion of the 
 rig-lit. But are the deductions drawn from these ex- 
 periments not open to doubt ? I think they are ; at all 
 events, they are certainly not beyond the reach of fair 
 and legitimate criticism. 
 
 In the first place, although the results claimed for 
 them are so startling, and of such momentous importance, 
 I am not aware that they have even been confirmed by 
 subsequent observers. I find that my scepticism is 
 shared by no less an authority than Professor Bernheim 
 of Nancy, who, in a private communication to me, 
 attributes the phenomena observed to " suggestion." " It 
 has been thought," says he, " at La Salpetriere, that the 
 hypnotised, whilst in a state of lethargy, are unconscious 
 
 * Nouveau. fait a. l'appui de la localisation de Broca, par G. Ballet. 
 " Progres Medical," Sep. nth, 1880, p. 78. 
 
BEARING UPON THE LOCALISATION OF SPEECH. 337 
 
 and do not hear ; whereas they hear everything, and 
 often strive to guess what the observer is desirous of 
 eliciting from them. A hypnotised person who has never 
 witnessed Charcot's experiments, and who is not aware 
 of what is desired of her, will certainly never exhibit the 
 phenomena described. It is entirely an affair of sugges- 
 tion ; the experiments are misleading, and can in nowise 
 help to solve the difficult questions connected with the 
 pathology of aphasia." 
 
 My friend, Dr. Hack Tuke, whose researches upon this 
 subject are so well-known, has favoured me with a 
 letter in reply to my inquiry, in which he says that he 
 has never been able to convince himself that hypnotic 
 experiments, which appear to support the alleged 
 function of Broca's convolution, are free from that 
 subtile and constant source of fallacy — unintentional 
 suggestion. In an article on "Artificial Insanity" in the 
 Journal of Mental Science for 1865, and also in his 
 "Influence of the Mind upon the Body, with especial 
 reference to the imagination" (1872), Dr. Tuke has 
 insisted on the numerous influences of imagination 
 and suggestion in so-called animal magnetism and 
 hypnotism* 
 
 * In his more recent work on " Sleep-wa'king and Hypnotism," Dr. 
 Tuke, in describing the characteristics of the mental condition in hypnotism, 
 dwells upon the extreme susceptibility to outside suggestions as being most 
 surprising. " The individuality of the hypnotic subject being deleted for 
 the time, he represents the logical consequence of the organisation of men 
 in society who are practically will-less, who are at the mercy of every 
 suggestion, however absurd, and every crotchet, however wild and un- 
 practical. This ideoplastic state finds its analogue also among the actually 
 insane, the tyrant of their organisation — that which tyrannises over their 
 thoughts and lives — being some fixed idea or a disordered perceptive centre, 
 or in the absence of these, the unwholesome susceptibility to the influence 
 
33§ SUGGESTION A FACTOR IN HYPNOTIC RESULTS. 
 
 Furthermore, whilst engaged in writing this section, 
 my attention has been called to a report of a curious 
 illustration of the effects of hypnotic suggestion, lately 
 witnessed at St. James' Hall, London. It is stated that 
 a mesmerist threw a gentleman named King into a 
 mesmeric trance so profound, that the passage of a 
 needle through the fleshy part of his arm caused no 
 sensation. In this state, Mr. King gave humorous 
 lectures and very curious imitations of Mr. Gladstone, 
 Mr. Irving, Mr. Grossmith, and Dr. Parker. He was 
 told by the mesmerist that he was each and all of these 
 persons, and quite unconsciously he accepted the res- 
 ponsibility. 
 
 Moreover, Professor Charcot himself, as I have else- 
 where stated, admits that hysterical mutism can be 
 produced artificially by hypnotism ; and in the appendix 
 to the third volume of his "Diseases of the Nervous 
 System," one of his pupils, M. Cartaz, thus describes in 
 detail how by hypnotic suggestion, hysterical mutism is 
 produced. During the period of somnambulism, the 
 patient is made to converse ; the observer then lowering 
 his voice, says to her, " I don't understand you. What 
 
 of others, as in the case of the unstable hysterical girl who adores every 
 curate she meets with, and would willingly do anything he tells her to do ! " 
 Dr. Tuke then illustrates his views, by a detailed account of the clinical 
 history of a young girl, a patient at Guy's Hospital under the care of 
 Dr. Wilks, in whom the effects of suggestion^ when in a hypnotised con- 
 dition, were very striking ; in fact, she was made to do almost whatever 
 was suggested. She could be rendered stone deaf, on being told that she 
 could not hear; but the moment the observer said to her, "Now you can 
 hear," she was released from the spell. On the idea being suggested to her 
 that her hands were being cut off, nothing could induce her to use her 
 fingers ; the will was the slave of a suggestion, an automaton was sub- 
 stituted for the true volitional self. 
 
ANATOMICAL OBJECTIONS. 339 
 
 do you say ? Why, you can't speak." And in an 
 instant the patient is aphasic, being unable to speak or 
 to phonate. This, says M. Cartaz, is the exact repre- 
 sentation of the mental disturbance observed in hysterical 
 patients. 
 
 Whilst, therefore, recognising the scientific interest 
 attaching to these curious experiments, I cannot admit 
 that the inference that has been drawn from them is a 
 logical one ; and I think they should not be cited as 
 confirmatory of the localisation of speech in the left 
 hemisphere of the brain. 
 
 I am not at all sure that there may not also be an 
 anatomical objection to the deductions which have been 
 drawn from these experiments. 
 
 In a former chapter, I have entered at some length 
 into the consideration of the different theories of the 
 visual centre, and I have shown that the whole subject 
 is far from being definitely settled, as the most divergent 
 notions exist as to the course of the fibres at the 
 chiasma, between it and the mesocephalic ganglia, and 
 again between these and the cerebral cortex. Moreover, 
 Charcot's assumption that there is a supplementary 
 crossing of the fibres of the optic tracts in the corpora 
 quadrigemina, by which all fibres from one retina would 
 pass to the opposite hemisphere, is by no means re- 
 cognised as absolutely correct; indeed, Charcot himself 
 speaks of it only as a hypothesis not based, at present, 
 on any anatomical grounds, but, nevertheless, supplying 
 a ready means of presenting, in a very simple form, the 
 rather complex facts revealed by clinical observation! 
 
 I need scarcely point out, that if there be no other 
 decussation of the optic fibres but that which is said to 
 take place at the chiasma, stimulation of one retina 
 
340 THE DECUSSATION OF THE OPTIC FIBRES AND 
 
 should affect both hemispheres equally, and the Sal- 
 petriere experiments would lose all their import — that is 
 assuming that the prevailing opinion is correct, that the 
 crossing of the fibres at this point is only partial. I am 
 aware that this partial decussation is not admitted by 
 all anatomists, and that the course of the optic fibres is 
 still a matter of dispute ; in fact, certain German 
 anatomists, Biesiadecki, Mandelstamm, and Michel, 
 maintain that the fibres of the optic nerves undergo 
 complete decussation at the chiasma, as occurs in fishes, 
 amphibia, reptiles, and birds; and Charcot himself ad- 
 mits that the question is far from being settled, and that 
 the semi-decussation is to be looked upon simply as a 
 theory which, however, explains the facts observed in 
 clinical medicine. I find that Ferrier also, in describing 
 Charcot's scheme, characterises it as unsatisfactory, and 
 in contradiction with now well-established clinical, as 
 well as experimental facts ;*" it is therefore clear that 
 the exact course of the fibres of the optic nerves is still 
 undefined ; and perhaps no question of late years has 
 excited so much controversial discussion as the exact 
 determination of the visual centre. 
 
 The whole subject of the course of the fibres of the 
 optic tract, and of the nervous connections which exist 
 between the retina and the brain, is discussed in an ex- 
 haustive manner by Professor Grasset, of Montpellier, 
 who rejects the schemes both of Charcot and of his pupil 
 Fere, for which he substitutes one of his own, frankly 
 admitting, however, that it is purely hypothetical, but 
 may be useful as a means of graphically representing 
 the actual state of our knowledge of this difficult subject 
 
 * Functions of the Brain, 2nd edition, p, 289. 
 
ITS BEARING UPON THESE EXPERIMENTS. 34I 
 
 of cerebral semeiology ;* M. Grasset recognises three 
 decussations of the optic fibres ! 
 
 i° Semi-decussation at the chiasma, where the internal 
 fibres cross, whilst the external fibres continue in a direct 
 course. 
 
 2° The external fibres cross in the neighbourhood of 
 the corpora quadrigemina, so that by this arrangement 
 the decussation is complete; and thus all the optic 
 fibres from one eye are re-united in the internal capsule 
 of the opposite hemisphere. 
 
 3° The external fibres undergo a further decussation 
 beyond the internal capsule, before terminating in the 
 convolutions of the hemisphere ; and by this means each 
 occipital lobe will contain the external fibres from the 
 eye of the same side, and the internal fibres from the 
 opposite eye. 
 
 M. Grasset adds that this triple seat of partial decussa- 
 tion seems to be indispensable for the proper interpreta- 
 tion of certain clinical facts ; as to the exact locality in 
 which it occurs, he suggests that it may be in the corpus 
 callosum. He admits that the above arrangement is 
 somewhat complex, but that the facts to be explained 
 are of a no less complex character also. 
 
 Another author, Michael Foster, in writing upon this 
 subject, says that the nervous centre is not a double 
 centre with two completely independent halves, one for 
 each eye ; there is a certain amount of communion be- 
 tween the two sides, so that when one retina is stimulated 
 both pupils contract.f The authors of the Salpetriere 
 experiments of course assume that one retina only is 
 stimulated, and only one hemisphere plunged into 
 catalepsy. 
 
 * Traite pratique des maladies du Systeme Nerveux, pp. 261 — 269. 
 t Text Book of Physiology, 4th Edition, p. 501. 
 
342 COURSE OF THE OPTIC TRACTS AND ITS BEARING 
 
 Besides the conflicting opinions as to the points of 
 decussation of the optic nerves, there would seem to be 
 a further objection to the acceptance of the inference 
 drawn from the Salpetriere experiments in reference to 
 the localisation of the faculty of speech. In order to 
 establish any connection between these experiments and 
 the localisation of speech, it is necessary to assume that 
 the fibres of the optic tract find their way into the 
 anterior lobes of the brain — the supposed seat of 
 speech — which is by no means universally admitted. 
 
 The course of the fibres of the optic tract between the 
 external geniculate body and the cortex of the brain is 
 not well ascertained, and is still the subject of scientific 
 inquiry ; at all events, a great diversity of opinion exists 
 in reference to it. Gratiolet asserted that the optic 
 tract is directly connected with every part of the cerebral 
 hemisphere in man, from the frontal to the occipital 
 region ; and Professor Hamilton of Aberdeen, in a com- 
 munication to the Royal Society on " The Cortical 
 connections of the Optic Nerves," expressed the same 
 opinion.* 
 
 In treating of this subject, that careful and accurate 
 observer, Dr. Ross, says that both anatomical and 
 physiological, as well as pathological observations, make 
 it certain that most, if not all, of the fibres of the optic 
 tracts terminate in the cortex of the occipital lobes ; but 
 that the course of the fibres in the intervening space 
 between the cortex and the external geniculate body, is 
 the subject which has excited the greatest controversy.! 
 Dr. Gowers, in a private communication with which 
 
 * Proceedings of the Royal Society, No. 232, 1884. 
 
 t Diseases of the Nervous System, 2nd Edition, Vol. L, p. 3S5. 
 
UPON THE SALPETRIERE EXPERIMENTS. 343 
 
 he lias favoured me, expresses himself very decidedly 
 upon the point in question; and his views of the physiology 
 of the cortex would exclude altogether the idea of any 
 passage of fibres from the optic tract to the motor speech 
 region. 
 
 I have thought it desirable thus to enter at great 
 length into the consideration of the bearing the experi- 
 ments made at La Salpetriere upon persons in a state of 
 hypnotism, may have upon the subject I am treating ; 
 but I must think that our knowledge of the exact 
 construction of the visual centre, of the precise distri- 
 bution of the fibres of the optic tract, and of the relation 
 of the two visual centres to each other, is at present so 
 imperfect as not to justify the originators of the above 
 interesting experiments to quote them as evidence of the 
 localisation of speech in the left hemisphere of the brain. 
 
 I now arrive at the consideration of the views of 
 M. Broca, whose researches lead him to confine the seat 
 of speech to a very narrow limit — the posterior part of 
 the third frontal convolution of the left hemisphere! 
 
 However startling this assertion may be, a considerable 
 number of observations have been recorded, which, at 
 first sight, would seem to substantiate it ; and in the 
 previous pages I have quoted several cases published by 
 careful observers, which give a general support to this 
 exclusive doctrine. Perhaps one of the most striking 
 observations that have been cited in support of M. Broca's 
 localisation is that of Simon, which I have recorded 
 in extenso at page 259; the subject of it fell from his 
 horse on his head, and suddenly became speechless, with 
 no motor paralysis of any kind ; after death, a spiculum 
 of bone which had become detached from the inner 
 
344 LOCALISATION OF THE FACIJLTY OF SPEECH 
 
 table of the left parietal bone, was found embedded in 
 the left frontal convolution. Another observation by 
 Rosenstein is equally significant, showing that a hsemorr- 
 hagic softening, only as large as a hazel-nut, in the left 
 third frontal convolution, can give rise to aphasia and 
 agraphia as the only symptoms.* 
 
 M. Magnan also presented to the Societe de Biologie, 
 in Paris, the brain of a woman who had for sometime 
 suffered from aphasia; the brain contained a large 
 glioma of the dura mater which had penetrated deeply 
 into the third left frontal convolution. At first sight 
 this case which was quoted in the English press, would 
 seem to lend a powerful support to Broca's theory ; but 
 having some doubts about its value, I consulted the 
 Transactions of the Societe de Biologie, and there I find 
 that the tumour (of which a plate is given) had en- 
 croached upon various other structures besides the third 
 frontal convolution, as will be seen from the following 
 extract from the original communication : — 
 
 " Reposant par sa base sur la face interne de la dure-mere, son 
 sommet plonge profondement dans l'hemisphere gauche qu'elle a 
 creuse et refoule au niveau de la moitie posterieure des deux pre- 
 mieres frontales et des deux tiers superieurs de la frontale ascend- 
 ante. De cette moitie des deux frontales, on ne distingue plus que 
 le pied, qui s'insere sur la frontale ascendante et qui est presque 
 completement efface. La tumeur penetrant a la fagon d'un coin 
 dans rhemisphere gauche, ecarte et refoule toutes les parties 
 voisines, et son sommet penetre jusqu'a la hauteur de la troisieme 
 frontale gauche et du tiers anterieur du bord superieur de l'insula. 
 Retiree de sa cavite, la tumeur mesure par son cote oblique 7 cen- 
 timetres et 4 centimetres seulement du cote oppose qui est droit." 
 
 I have thought it best to give the above description of 
 the morbid appearances in M. Magnan's own words, by 
 
 * Berl. klin. Wochenschiifi, 1S71, s. 599. 
 
IN THE THIRD LEFT FRONTAL CONVOLUTION. 345 
 
 which it will be seen that from the size of the tumour 
 and the pressure exercised by it on various structures 
 all around, this case is utterly valueless as evidence in 
 favour of localisation; and it shows how clinical obser- 
 vations, unless minutely analysed, are liable to be 
 misinterpreted, and made to fit in with preconceived 
 theories, upon which they really have no bearing. 
 
 In the same communication, M. Magnan gives the 
 clinical details of three other cases of aphasia, in which 
 the third frontal convolution was found to be diseased ; 
 in all three instances, however, the island of Reil par- 
 ticipated in the lesion to a considerable extent, and he 
 adds that the coincidence of lesions of the insula and of 
 the third frontal convolution is very frequent in aphasia, 
 and, moreover, that in some instances the disease is but 
 slightly apparent in the third frontal, but strikingly 
 marked in the insula ; furthermore, that in some cases, 
 the disease is entirely limited to the latter, the former 
 being quite healthy. 
 
 Let us now weigh in the balance of impartial criticism 
 the case which has served as the foundation stone upon 
 which M. Broca has erected his theory. I allude, of 
 course, to the case of Tan, the details of which I have 
 already given. This observation has been quoted by 
 writers in all parts of the world as a case of aphasia from 
 lesion of the third left frontal convolution ; indeed, it 
 was the very case which resulted in the conversion of its 
 author to the unilateral theory. Now, on referring to 
 the description Ihave given of Tan's autopsy, it will be 
 seen that, in addition to the disease in the second and 
 third left frontal convolutions, upon which M. Broca lays 
 such stress, the following morbid conditions were also 
 observed : — Thickening of the cranium and of the dura 
 
34 6 THE LOCALISATION OF THE 
 
 mater, universal infiltration of the pia mater with yellow- 
 ish plastic matter of the colour of pus. The greater 
 part of the left frontal lobe was softened, and a cavity of 
 the size of a hen's egg was caused by the destruction 
 of the inferior marginal convolution of the temporo- 
 sphenoidal lobe, the convolutions of the island of Reil, 
 and the subjacent part or extraventricular nucleus of the 
 corpus striatum. It will also be observed that the 
 weight of the encephalon was less by 14 ounces than 
 the average weight of the brain in men of fifty years of 
 age. As the softening, instead of being limited to 
 Broca's region, involved the greater part of the left 
 frontal lobe, surely it implies a breach of the laws of 
 probability, to assume that the disease commenced in 
 the third frontal convolution 21 years before his death, 
 simply because the softening was most apparent at that 
 spot, which M. Eroca considers was the primary seat of 
 mischief at the period of the clinical history during which 
 the faculty of speech alone was abolished. 
 
 It will be observed that Broca's theory implies that 
 aphasia is akvays and only present when the third left 
 frontal convolution is diseased ; now two classes of 
 observations have been advanced against this position : — 
 i° those in which aphasia occurred with complete in- 
 tegrity of the third left frontal convolution ; 2° those in 
 which there was found positive lesion of this convolution 
 without disturbance of speech. 
 
 In the first category may be mentioned the various 
 cases that I have quoted from the works of Charcot, 
 Vulpian, Trousseau, and others ; of those that are recorded 
 as having fallen under my own personal observation, a 
 careful autopsy was made in five instances, when the 
 frontal convolutions were in each case invariably found 
 
FACULTY OF ARTICULATE LANGUAGE. 347 
 
 to be healthy. Wishing to avoid useless repetition, I 
 will refer my readers to the fourth chapter of this treatise, 
 where the clinical history of my own cases, as well as the 
 post-mortem appearances, are detailed at considerable 
 length. The history of William Sainty (see page 100) 
 is especially interesting ; it was a typical case of aphasia, 
 was under close observation for several years, and after 
 death there was found softening of the middle of the 
 posterior lobes, with no trace of disease in the frontal 
 convolutions. 
 
 The advocates of M. Broca's views will charitably say 
 that there may have been some slight disease of the 
 frontal convolutions not patent to my means of investi- 
 gation. This is an objection that may be raised against 
 all negative cases ; but granted that there may have 
 been some slight change in the texture of the third left 
 frontal convolution not appreciable to my senses, the 
 whole history of this case points to the certain conclu- 
 sion, that the fous et origo mail was in the posterior 
 lobes, and here must have been the commencement of 
 disease, when, four years before his death, the first and 
 only morbid symptom showed itself in the total suspen- 
 sion of the faculty of articulate language. 
 
 The second category of cases at variance with Broca's 
 views, embraces those where a positive lesion of the 
 third left frontal convolution existed without aphasia. 
 It was formerly stated by M. Broca, and repeated by 
 M. Jules Falret and Dr. Win. Ogle, that there was no 
 example of this condition ; it will, however, be remem- 
 bered that I have quoted such a case at page 67, as 
 reported by Dr. Simpson of the Gloucester Asylum. 
 Dr. Long Fox, of Bristol, has observed a case of syphilitic 
 disease of the left frontal convolution involving- Broca's 
 
34-8 THE LOCALISATION OF SPEECH. 
 
 region, the power of speech being unimpaired;* and 
 Mr. Messenger Bradley has reported a case in which there 
 was no aphasia, although the third left frontal convolu- 
 tion was as thoroughly destroyed as if ablation had been 
 performed. | A goodly number of similar instances have 
 been recorded of disease of this gyrus without aphasia, 
 the most striking of which is that observed by Dr. Fonlis 
 of Glasgow, where the patient could talk with perfect 
 fluency and correctness, although the third left frontal 
 convolution was found completely destroyed with the 
 exception of a thin shred at the extreme posterior end ; 
 the island of Reil was also to a large extent excavated. £ 
 Furthermore, M. Moreau (de Tours) has observed at 
 La Salpetriere a case of congenital absence of the third 
 left frontal convolution, as well as of the inferior parietal 
 and the superior temporo-sphenoidal convolutions on 
 the same side — or, in other words, all that part of the 
 left hemisphere which bounds the fissure of Sylvius, and 
 which is known in M. Foville's nomenclature as la circon- 
 volution d'enceinte de la fissure de Sylvius, had never 
 become developed. Now, if the third left frontal con- 
 volution, or even its immediate neighbourhood, were the 
 exclusive seat of speech, this patient ought to have been 
 aphasic, which, it is stated, was not the case.§ 
 
 * Lond. Hosp. Reports, vol. iv., p. 350. 
 
 f Brit. Med. Journal, June, 1873. 
 
 J For a full description of this important observation, vide page 77. 
 
 § M. Broca, in referring to this case, the importance and significance 
 of which he fully admits, says, that when the third left frontal convolution — 
 the ordinary seat of articulate language — is congenitally deficient, the in- 
 dividual learns to speak with the third right frontal convolution, just in the 
 same way as a child born without the right hand, becomes as skilful with 
 the left, as others are with the right hand. 
 ;-'M. Legroux, in commenting upon observations of this description, says 
 
lohmeyer's statistics. 349 
 
 It will thus be seen that we can have aphasia without 
 disease of the third left frontal convolution, and vice 
 versa ; that this gyrus may be diseased, destroyed, and 
 even congenitally absent, without giving rise to any dis- 
 turbance of speech. 
 
 Since the publication of M. Broca's pamphlets, the 
 attention of the profession in all parts of the world has 
 been directed to the question of the cerebral localisation 
 of speech, and evidence of the most conflicting character 
 has been accumulating in reference to the various theories 
 of localisation that I have been discussing. 
 
 Some interesting and important statistics have been 
 published by Lohmeyer. This observer has collected 
 53 carefully described cases of aphasia, in which an 
 autopsy was made. In 50 of these cases, the loss of 
 speech depended upon a lesion of the left hemisphere, 
 the lesion being 24 times in the third frontal convolution ; 
 34 times in it and its neighbouring parts, including the 
 island of Reil, which was 7 times concurrently affected ; 
 13 times in the left island ; 6 times in this alone.* 
 
 On reviewing the evidence contained in the preceding 
 pages, as far as it bears on the question of localisation, 
 it will be seen that a certain number of cases have been 
 recorded that are at variance with all the different 
 theories that I have been considering. Incontestable 
 and patent lesions have been observed in the different 
 
 that they ought not to be considered as antagonistic to M. Broca's views, 
 with which they can be reconciled by the assumption that the right hemis- 
 phere may, under exceptional circumstances, be able to assume the function 
 ordinarily belonging to the left. De l'aphasie, These pour l'agregation,. 
 1875, P- 42- 
 * Archiv. f. klin Chirurgie, 1872, xiii., s. 309. 
 
350 LOCALISATION OF SPEECH. 
 
 regions where it has been attempted to localise speech, 
 and such lesions have not been accompanied by any 
 derangement of that faculty; and I need scarcely re- 
 mark that a well established case of destruction of both 
 anterior lobes without lesion of speech would be fatal to 
 both Bouillaud's and Dax's views, and would a fortiori 
 upset Broca's theory also. Although many such cases 
 have been recorded, critics have urged that there may 
 have been, and probably were, some small portions of 
 the lobes left, or at all events, that the third left frontal 
 convolution may have escaped. To this reasoning, 
 I would reply that, as far as function is concerned, 
 isolation would be identical with complete destruction. 
 On the other hand, evident cases of aphasia have been 
 recorded which coincided with no alteration whatever of 
 those parts of the encephalon to which the seat of speech 
 has been assigned. 
 
 No subject of late years has so occupied the attention 
 of physiologists in all parts of the world, as the attempt 
 to localise the grand attribute of humanity, the faculty of 
 speech ; but, I am bound to say that in spite of all that 
 has been written in reference to it, the question must 
 still be considered as sub judice, and an impartial sifting 
 of the mass of evidence I have accumulated has led me 
 to the following conclusions : — 
 
 i°. That although something may be said in favour of 
 each of the popular theories of the localisation of speech, 
 still, so many exceptions to each of them have been re- 
 corded, that they will none of them bear the test of a 
 disinterested and impartial scrutiny. 
 
 2° That aphasia certainly is not invariably connected 
 with lesion of the left anterior lobe of the brain. 
 
 3° That the converse of this is not true also — namely, 
 
SEAT OF SPEECH NOT A MATHEMATICAL POINT. 35 I 
 
 that when a positive lesion of the left anterior lobe exists, 
 aphasia is necessarily one of the symptoms ; moreover, 
 medical literature contains numerous instances of exten- 
 sive lesions of both anterior lobes without serious im- 
 pairment of speech, and cases of this description, re- 
 corded by competent observers, must be taken into 
 serious account in settling the question of localisation ; 
 they must be faced by the localisers, and their signifi- 
 cance cannot be ignored. 
 
 4 . That it must, however, be conceded that in the 
 immense majority of cases, aphasia has been found 
 associated with disease in the left anterior lobe, and 
 more especially in the third left frontal convolution or 
 its immediate neighbourhood ; and the concurrence of 
 derangements of speech with lesions of this limited area 
 is so strikingly frequent, as to take it altogether out of 
 the region of mere chance. 
 
 I, however, agree with Professor Grasset, of Mont- 
 pellier,* that the seat of articulate language (if there be 
 one) is not a ' mathematical point ' which can be definitely 
 circumscribed; for although in a large number of cases 
 loss of speech corresponds with a lesion of the third left 
 frontal convolution, the island of Reil is frequently 
 simultaneously affected, and in some rare instances, this 
 region has been found to be alone diseased. 
 
 The question of the localisation of cerebral faculties 
 has not been confined to physiologists, but has excited a 
 
 * Traite pratique des maladies du Systeme Nerveux, p. 172. In this 
 very elaborate and exhaustive treatise, as well as in his work on " Les 
 Localisations Cerebrales," M. Grasset has entered most fully into the con- 
 troversial aspect of the pathology of aphasia. Both these treatises have 
 been most serviceable to me, and are well worthy of careful study for their 
 sound anatomical knowledge, their wealth of illustration, and their felicity 
 of expression. 
 
 Z 
 
352 SPENCER AND ROMANES ON LOCALISATION. 
 
 good deal of interest in the literary world generally ; 
 and it is curious to notice how some non-medical writers 
 have expressed themselves with a dogmatic precision 
 not justified by the evidence at their command. 
 
 Herbert Spencer, after stating that most physiologists 
 have not sufficiently recognised the general truth of 
 which phrenology is an adumbration, goes on to say 
 that 'whoever calmly considers the question, cannot long 
 resist the conviction that different parts of the cerebrum 
 must, in some way or other, subserve different kinds of 
 mental action. Localisation of function is the law of 
 all organisation whatever; and it would be marvellous 
 were there here an exception. ... It is proved, 
 experimentally, that every bundle of nerve-fibres and 
 every ganglion has a special duty ; and that each part 
 of every such bundle and every such ganglion has a 
 duty still more special. Can it be, then, that in the 
 great hemispherical ganglia alone, this specialisation of 
 duty does not hold? . . . Just as there are aggre- 
 gated together in a sciatic nerve an immense number of 
 fibres, each of which has a particular office referring to 
 some one part of the leg, but all of which have for their 
 joint duty the management of the leg as a whole; so, in 
 any one region of the cerebrum, each fibre may be con- 
 cluded to have some particular office, which, in common 
 with the particular offices of many neighbouring fibres, 
 is merged in some general office fulfilled by that region 
 of the cerebrum. Any other hypothesis seems to me, 
 on the face of it, untenable.'* 
 
 Another writer, Mr. G. J. Romanes, in his recent work 
 on " Mental Evolution in Man,"f trenches the question in 
 
 * The Principles of Psychology, vol. i., 2nd edition, p. 573. 
 t This work may be consulted with advantage by the student of linguistic 
 
THE AMERICAN MEDICAL CONGRESS. 353 
 
 a very decided manner, remarking that the evidence 
 available has fully satisfied all living physiologists that 
 the faculty of articulate language has a material locus 
 habitandi ; and he insists upon the propriety of the ex- 
 pression " Seat of Speech." We shall see presently 
 whether the views of living physiologists on the subject 
 harmonise as completely as Mr. Romanes so confidently 
 asserts. As Mr. Romanes' views upon this subject are 
 contained in a very courteous and temperate criticism of 
 my treatise on " Darwinism tested by Language," I must 
 refer him to the 7th chapter of that work, where cer- 
 tain arguments are used with which he does not seem 
 to be familiar. 
 
 The question of cerebral localisation formed a promi- 
 nent feature of the Congress of American Physicians and 
 Surgeons held at Washington in September, 1888, at 
 which several of the leading American neurologists 
 expressed their views upon this much disputed point. 
 The subject was introduced by Dr. Charles K. Mills, of 
 Philadelphia, in an exhaustive essay upon the various 
 points in dispute ; the doctrines of cerebral localisation 
 and the principles of cerebral symmetry were lucidly 
 expounded by Dr. Mills and Dr. Park, Professor of 
 Surgery in the University of Buffalo ; the former dwelling 
 chiefly on cerebral localisation in its practical relations, 
 and the latter on the Surgery of the Brain as based on 
 the principles of cerebral localisation. Dr. Allen Starr, 
 of New York, then followed with an elaborate essay on 
 Aphasia, which gave rise to a lengthened discussion, in 
 
 science, as its author devotes four chapters to the consideration of the 
 different forms of language, employing the word in the wide sense in which 
 Broca used it — the faculty of establishing a constant relation between an 
 idea and a sign. 
 
354 DISCUSSION ON CEREBRAL LOCALISATION AT 
 
 which Dr. Ferrier and Mr. Victor Horsley of London, 
 Dr. Keen of Philadelphia, and Dr. Weir of New York, 
 took part. 
 
 Dr. Starr, after stating that there is a consensus of 
 opinion, based upon a large number of cases, that motor 
 aphasia is produced by lesion of Broca's convolution, 
 qualified this statement by adding that ' Broca's centre is 
 connected with the cranial nerve nuclei by a nerve 
 tract which transmits the impulses that start the speech 
 mechanisms ; and lesions in this tract appear to cause as 
 true a motor aphasia as lesions at its origin. The 
 differentiation between cortical and subcortical lesions 
 meets us here at once. The only method of diagnosis 
 is the study of collateral symptoms accompanying the 
 aphasia, and the study of the history of the case which 
 may settle the nature of the lesion, and thus aid to its 
 localisation. If that lesion is just beneath the cortex, it 
 cannot be distinguished from a lesion of the cortex. If 
 it is in the speech tract as far from the cortex as the 
 internal capsule where it will not injure the commissural 
 fibres between the two lobes, the aphasia will be only 
 temporary ; the impulses are there supposed to cross 
 from Broca's centre to the other hemisphere, and thence 
 go down to the nuclei ; and in this case, other symptoms 
 of capsular or basilar lesion will be present to indicate the 
 site of t^e disease. This distinction is important, for 
 while Broca's centre is easily accessible to the surgeon, 
 as one of Macewen's cases proves, the time has not yet 
 come when he can reach the internal capsule.'* 
 
 * Transactions of the American Congress, p. 333. Dr. Starr's com- 
 munication was illustrated by a diagram of 44 cases of word-blindness 
 and of word-deafness ; in it, the lateral surface of the brain, as shown by 
 Ecker, is divided into squares ; when, in a given case, the area indicated by 
 
THE MEDICAL CONGRESS AT WASHINGTON. 355 
 
 Considerations of space prevent me from dwelling 
 further upon this most interesting and instructive con- 
 gress ; I must, however, make a passing allusion to the 
 remarks of Mr. Victor Horsley, as being pertinent to the 
 subject that I am considering in this chapter. Mr. 
 Horsley, who expressed his views at great length, after 
 speaking of the motor centres generally, said that the 
 result of his experiments was to show that ' there is no 
 hard and fast line limiting the representation of any 
 given segment — that there is no area of the cortex, over 
 which any particular segment is equally represented 
 throughout, but that in one spot especially the represen- 
 tation is concentrated and thence diminishes gradually.' 
 
 Professor Hammond of New York, whose researches 
 upon this subject are so well known, says in his second 
 edition, that after giving full consideration to the facts 
 and arguments which have been urged on all sides, 
 whilst rejecting the restricted location of Dax, and the 
 
 one of these squares was invaded by the disease, the number of that case is 
 put down in the square. Without wishing to criticise Dr. Starr's interest- 
 ing diagram, I must point out that the first case on his list, which is one that 
 he has done me the honour to quote from the first edition of this work, as 
 an instance of word-blindness, presents none of the features of that singular 
 affection, as will be seen by a reference to the clinical history as reported at 
 page 109 of the present edition. In commenting upon his diagram, Dr. 
 Starr adds that ' the great preponderance of numbers in the temporal and 
 lower parietal regions, shows that this site is the seat of lesion in the large 
 majority of cases of Sensorial Aphasia. Some of the cases presented exten- 
 sive lesions outside of the speech area, as well as in it; but in none was* 
 Broca's centre destroyed or invaded by disease. ... In all speech 
 processes, an association of various memory pictures is constantly going on. 
 Certain recent advances in the knowledge of aphasia give us indications 
 sufficiently definite to be of practical use ; for though we have to admit 
 several speech areas instead of one speech centre, there is no reason why 
 motor, or sensory, or mixed aphasia should not be taken as guides to 
 operation as reliable and satisfactory as monospasm or hemianopsia.' 
 
356 VIEWS OF PROFESSORS LADD AND HUGUENIN. 
 
 still more limited situation contended for by Broca, he is 
 constrained to believe that the organ of language is 
 situated in both hemispheres, and in that part which is 
 nourished by the middle cerebral artery. As I have 
 not access to his last edition, I do not know how far 
 recent investigations may have modified Dr. Hammond's 
 views, but in a letter received from him quite recently, 
 he says, ' I am not so thorough going a localiser of the 
 organ of speech as are Grasset and others ; the speech- 
 tract is for me quite a large region.' 
 
 Professor Ladd of Yale College, U.S., in his " Elements 
 of Physiological Psychology," in refusing to limit too 
 narrowly the localisation of such a complex faculty as 
 speech, says : ' The literal meaning of the statements 
 made by Broca — such as that this part of the brain is 
 the seat of articulate language, is not simply inappro- 
 priate to the facts, it is even absurd. There is no one 
 faculty of language which can, in any possible meaning of 
 the word, be regarded as having its seat or locality con- 
 fined to some particular region of the brain. Speech 
 involves, in a very complicated and large way, all the 
 faculties. Strictly speaking, then, it cannot be located, 
 with all its attendant operations of self-conscious, 
 rational mind, in any one cerebral area.' 
 
 Professor Huguenin says that the question of the 
 localisation of speech is one which especially requires 
 reserve in judgment, for the physiological value of what 
 we know concerning the localisation of aphasic disturb- 
 ances has been considerably over-estimated ; especially 
 when one stubbornly insists, as some do, that it is con- 
 nected with Broca's convolution.* Professor Goltz, of 
 
 * Ziemssen's Cyclopaedia, vol. xii. , p. 789. 
 
THE BRAIN COMPARED TO A VIOLIN. 357 
 
 Strassburg, also, whose physiological researches have 
 recently attracted so much attention, expresses a very 
 decided opinion as to the non-existence of a limited 
 centre for speech in the brain. 
 
 Amongst those who object to the mapping out with 
 mathematical exactitude the functional topography of 
 the cortex is Professor Brown-Sequard, who in a recent 
 letter with which he has favoured me, says : ' I deny that 
 there is any circumscribed part of the brain specially en- 
 dowed with the power of expressing ideas by speech, but 
 nervous elements which possess that function are scattered 
 through a great many parts of the brain. Aphasia, 
 whether coming from a lesion of the third frontal con- 
 volution, or from any other part of the brain, is due not 
 to the destruction of a few cells endowed with the 
 faculty of speech, but to an irritation starting from the 
 seat of the lesion, and going to all the cells having that 
 function, and which are scattered through the brain, 
 stopping the activity of nerve elements by an act of 
 Inhibition.'* 
 
 After duly weighing the conflicting evidence contained 
 in the preceding pages, I think the Scotch verdict of 
 " Not proven " may fairly be claimed in reference to any 
 arbitrary and definite localisation of the faculty of 
 speech ; and the most that can be conceded is that the 
 healthy action of a limited portion of the left hemisphere 
 
 * Dr. Ball, the Professor of Mental Pathology in the Faculty of Medicine 
 of Paris, has communicated to me his views upon this subject in the follow- 
 ing terms:—" The brain is not, as modern localisers would have it to be, a 
 piano, each key corresponding to a particular note ; but it may rather be 
 compared to a violin, on which a skilful artist can play almost any tune 
 upon one single string, when the other strings are cut — a feat actually per- 
 formed by Paganini." 
 
358 KUSSMAUL ON THE SEAT OF SPEECH. 
 
 seems to be necessary for the ontivard manifestation of 
 articulate language ; but this fact does not justify crediting 
 this area with being the Seat of Speech — an expression 
 which seems to me to be inappropriate and misleading. 
 I cannot do better than conclude this chapter with a 
 quotation from the classical work of Professor Kussmaul, 
 whose views I find are in consonance with my own. 
 " For the purposes of speech, there exists an apparatus 
 as vast as it is complicated. A simple centre of language 
 or Seat of Speech does not exist in the brain, any more 
 than a seat of the soul exists in a single centre. The 
 central organ of speech may be said to be composed 
 of a large number of ganglionic apparatuses, widely 
 separated from each other; but connected by numerous 
 tracts, and fulfilling certain intellectual, sensory, and 
 motor functions ; but it is probable that none of these 
 apparatuses subserve alone the objects of speech."* 
 
 * Die Slorungen der Sprache, cap. ix., s. 32. 
 
CHAPTER XII. 
 
 Consideration of certain collateral subjects indirectly connected wi'h the 
 Localisation of Speech. The minute Anatomy of the brain. Cerebral 
 asymmetry and its relation to criminality — the reduplication of the second 
 frontal convolution said to be common in murderers. The science of 
 Criminal Anthropology — its literature ; psychical anaesthesia. Great de- 
 velopment of the third frontal convolution in orators — the brain of 
 Gambetta. Physiology — dextral pre-eminence ; why is the human race 
 right-handed ? Experimental Pathology — differences between the brain of 
 man and that of animals. General Anthropology — the cranial researches 
 of Barnard Davis, Broca, Flower, and the Abbe Frere. Has the cranial 
 capacity of the population been increasing in proportion to the progress 
 of civilisation? Herodotus on the influence of head coverings on the 
 thickness of the skull. The Chemistry of the brain — Thudicum on the 
 phosphorised principles and the cerebromides. The phosphorus theory 
 considered — views of Couerbe and Feurbach. Conclusion. 
 
 It will be observed that I have hitherto considered 
 this question solely from a pathological stand-point ; but 
 it seems to me that the anatomist, the physiologist, the 
 comparative anatomist, and the anthropologist, can do 
 us good service ; and that it is to their researches, per- 
 haps even more than to those of the clinical physician, 
 that we are to look for the removal of the cloud which 
 now envelops the obscure subject of the localisation of 
 the faculty of speech. 
 
 In this concluding chapter, I have considered at much 
 greater length than in my first edition, certain collateral 
 matters which may be said to have only an indirect 
 bearing upon my subject, but which, however, may help 
 
360 MINUTE ANATOMY OF THE BRAIN. 
 
 the solution of certain difficulties connected with the 
 study of the localisation of our cerebral faculties.* 
 
 Anatomy. — Let me first consider whether the study 
 of the minute anatomy of the brain, and especially of the 
 cerebral convolutions, can help the question of the 
 localisation of the faculty of speech. 
 
 This is a subject entirely neglected by the older 
 anatomists ; in fact, Cabanis, the author of a classical 
 work on the revolutions of medicine, in the beginning of 
 the present century, pronounced the minute anatomy of 
 the brain as not only badly capable of being ascertained 
 by the scalpel or the microscope, but as ' rather an object 
 of physiological curiosity than of medical utility, and at 
 present wholly useless and likely to remain so.' Thanks to 
 the brilliant researches of modern anatomists, the cerebral 
 cortex is no longer a terra incognita; and although much 
 remains still to be done, it has been ascertained that 
 considerable variations exist in different parts of the 
 brain, in the number, character, and relative thickness 
 of the layers, and their precise division has been the 
 subject of much discussion ; it has moreover been shown 
 that there is a marked difference in the structure and 
 general character of the cortex, especially in the central 
 convolutions (ascending frontal, ascending parietal, and 
 paracentral lobule). 
 
 We may fairly assume that difference of structure 
 implies difference in function ; it is important, therefore, 
 
 * I may add that I have been induced to develop at greater length this 
 portion of my treatise, in deference to the wishes of the writer of a long 
 and far too complimentary notice of my first edition in one of the leading 
 medical periodicals, in which the reviewer suggested that this section of my 
 work might with advantage be considerably enlarged. 
 
THE SYMMETRY OF THE TWO HEMISPHERES. 361 
 
 to ascertain whether the generally assumed symmetry of 
 the two hemispheres is correct. There cannot be a 
 doubt that in general form the two opposite sides of the 
 brain are alike, or at all events, resemble each other so 
 closely, that no essential difference can be appreciated 
 by the naked eye — the two hemispheres being apparently 
 so nearly symmetrical and identical in structure, that 
 whatever may be said of the one, would, anatomically 
 speaking, apply to the other; the results, however, of 
 modern investigators, by substituting for the purely 
 graphic notion of eminences and depressions, a methodical 
 recognition of regular folds, constant in their form and 
 connections, have caused a corresponding revolution in 
 our ideas of cerebral physiology, by tracing a distinct 
 relation between the degree of development of the 
 different groups of convolutions and their intellectual 
 value. 
 
 Dr. Todd says that although the convolutions of 
 opposite hemispheres in the human subject cannot be 
 said to be absolutely unsymmetrical, yet a careful ex- 
 amination will show that if the same convolutions exist 
 on each side, they are of apparently different sizes, and not 
 closely corresponding as regards situation ; on the other 
 hand, he says, that in the imperfectly developed brains 
 of the idiot, or young child, as well as of the inferior 
 animals, the convolutions are quite symmetrical.*! 
 
 M, Broca, who never takes anything for granted, and 
 
 * Cyclopedia of Anatomy and Physiology, vol. iii., p. 369. 
 
 f Dr. Moxon considers that education is unilateral, that the brain be- 
 comes unsymmetrical in higher and more intelligent animals, and reaches 
 its greatest want of symmetry in man, whose early life is spent in the 
 acquirement of what he affirms to be one-sided educational developments. — 
 British and Foreign Medico-Chirurgical Review, vol. xxxvii., p. 489. 
 
362 THE SUPPOSED RELATION BETWEEN 
 
 whose indefatigable zeal led him to examine forty brains, 
 came to the conclusion that the convolutions are notably 
 more numerous in the left frontal lobe than in the right ; 
 and that the converse condition exists in the occipital 
 lobes, where the right is richer in convolutions than the 
 left. 
 
 In considering the question of cerebral symmetry, the 
 inequality in the development of the corresponding 
 regions of the skull should be taken into account. Of 
 287 skulls examined by Lebon, this author has observed 
 that in 125 cases the right side was most developed, in 
 in instances the left was the most prominent, and in 5 1 
 cases there was equality — symmetry in the two regions.* 
 
 Of late much has been written about cerebral anoma- 
 lies, and asymmetry, and an attempt has been made not 
 only to establish a relation between these anomalies and 
 aberrations of intelligence, but also between them 
 and alteration of the moral sense — "la criminalite." 
 Amongst those who have written upon this subject are 
 Benedikt in Germany, and Hanot and Fere in France. 
 
 It has been stated that in malefactors, there has been 
 observed an unfolding or reduplication of the second 
 frontal convolution, thus increasing the number of frontal 
 convolutions from three to four, as occurs in carnivorous 
 animals. Benedikt observed this arrangement in a large 
 number of brains of murderers, and Professor Bouchard, 
 of Bordeaux, informed the Anthropological Society of 
 
 Dr. Meynert has made a number of careful craniological studies on 
 the skulls of 128 lunatics who had died at the general hospital at Vienna ; 
 and he found that the capacity both of the male and female skull in lunatics 
 is greater than that of the normal skull, but that this superior cranial 
 capacity is not accompanied by any greater brain weight. — Jahrbuch fiir 
 Psychiatrie, Heft 2, 1879. 
 
CEREBRAL ASYMMETRY AND CRIME. 363 
 
 Paris, that he had verified the existence of this super- 
 numerary convolution in the brain of a young man who 
 had recently been guillotined. 
 
 Benedict asserts that if the brains of murderers do 
 not present real anomalies, they at least exhibit more 
 frequently than others, abnormal or rather unusual com- 
 munications between the convolutions. M. Fere\ in 
 writing upon this subject, observes that if the majority 
 of malefactors present only insignificant anomalies, there 
 exist, on the other hand, subjects that cannot be ranged 
 in the criminal category, that offer most important 
 malformations ; and he illustrates these remarks by the 
 history of a female not belonging to the criminal class, 
 where the asymmetrical anomalies were most striking. 
 He adds that it must be borne in mind that there are 
 scarcely two brains that resemble each other exactly, 
 and furthermore, that no brain is exactly symmetrical at 
 any period of its development, and it would seem that 
 this asymmetry is not special to man, but is found in the 
 monkey* M. Fere asserts that this unfolding of the 
 convolution does not constitute an anomaly, but merely 
 an anatomical variety which is observed in a large 
 number of persons not belonging to the criminal class ; 
 also that since Benedikt first called attention to this 
 subject, he has examined hundreds of brains, and has 
 acquired the conviction that the reduplication is a very 
 common anatomical arrangement. 
 
 It will be seen, therefore, that there is a great 
 divergence of opinion as to the existence of this fourth 
 frontal convolution, and I recommend the subject to 
 
 * Ch. Fere Contributions a l'etude de la topographie cranio -cereb rale 
 chez quelques singes.— Journal de l'anatomie et de la physiologie, 18S2, 
 P- 556. 
 
364 THE SCIENCE OF CRIMINAL ANTHROPOLOGY. 
 
 the consideration of the new sect of Criminal Anthro- 
 pologists, that has lately sprung up, by whom it will 
 doubtless be deemed important from a medico-legal 
 point of view. 
 
 The science of Criminal Anthropology has attracted so 
 much notice on the continent, that a journal has recently 
 been established — " Les Archives de l'Anthropologie 
 Criminelle," having for its object the dissemination of 
 scientific information bearing upon the genesis of crime ; 
 the criminal being studied as a distinct type of humanity, 
 presenting physical, as well as mental characteristics, 
 which separate him from ordinary men. One contributor 
 to this periodical, Enrico Ferri, a member of the Italian 
 parliament, asserts that all crime depends upon three 
 kinds of factors — anthropological, physical, or social. 
 The social factor (want, &c.) predominates in simple 
 theft, and the anthropological factor in murder ! The 
 same writer discusses the relation between crime and 
 thermometric variations. Another writer, also an Italian, 
 Professor Lombroso, seems to have established a new 
 class of the genus homo, under the title of " Uomo 
 delinquente."* 
 
 * Professor Lombroso regards the criminal as a reversion to the savage 
 type, and he gives a detailed description of the physical characters of the 
 habitual homicide with " the cold, glassy, immobile look ; the eyes some- 
 what bloodshot; the nose often aquiline or hooked; strong jaws, long 
 ears, large cheek-bones, hair crisp, abundant, and dark ; the canine teeth 
 prominent, thin lips, open nervous contractions of one side of the face, so 
 as to give a grimacing or threatening look." The above is the description 
 of a monster whom the French criminal anthropologists would characterise 
 as being afflicted with "l'hysterie du sang." 
 
 Amongst the various scientific congresses lately held in Paris, during the 
 period of the International Exhibition, was one on Criminal Anthropology, 
 when M. Manouvrier read a paper in which he stated that the characteristics 
 enumerated by Lombroso, have in many instances been observed in men of 
 
ON PSYCHICAL ANAESTHESIA. 365 
 
 The criminal anthropologists seem to have invented 
 a phraseology peculiar to themselves; persons who 
 commit heinous crimes in cold blood are said to be 
 affected with "psychical anaesthesia," a modification of 
 which is spoken of as "psychical dysaesthesia ! " In 
 psychical dysaesthesia, the feelings are perverted, im- 
 pressions vitiated, and there exists a true "psychical 
 neuralgia" which by degrees culminates into complete 
 "psychical anaesthesia." I ought to add that this lan- 
 guage is used more particularly in reference to criminal 
 lunatics, and in considering the medico-legal signification 
 of "psychical anaesthesia," we are cautioned against con- 
 cluding that all villains who murder their victims are 
 irresponsible agents. 
 
 I do not propose to enter upon the wide, delicate, and 
 much disputed question of the relation said to exist 
 between mental disturbance and criminality, nor am I 
 disposed to discuss the question as to whether there be 
 any necessary connection between moral and intellectual 
 sense and the gross morphology of the brain ; but I cor- 
 dially re-echo the sentiments of Professor Osier that ' one 
 thing is certain, that as society is at present constituted, 
 it cannot afford to have a class of criminal automata, and 
 
 spotless character ; therefore, they cannot be accepted as undeniable indi- 
 cations of criminal propensities. The presence of the metopic suture 
 having been cited as an indication of criminality, M. Manouvrier examined 
 in the Paris catacombs 28 crania, and in five this suture existed ; he con- 
 siders, therefore, that the presence of this suture is not an anomaly, but 
 only a peculiarity. 
 
 A further contribution has been made to criminal pathology by Dr. 
 Gradenigo, of Turin, who asserts that criminals show a marked prepon- 
 derance over other persons in respect of deafness ; he tested the hearing of 
 82 healthy male criminals, and he found more or less marked deficiency of 
 hearing in 55 of that number (67.3 per cent.) 
 
366 COMPARATIVE WEIGHT OF THE HEMISPHERES. 
 
 to have every rascal pleading guilty grey matter in 
 extenuation of some crime.'* 
 
 The comparative weight of the two hemispheres is an 
 interesting point to note. The researches of M. Broca, 
 made at Bicetre and at La Salpetriere, have shown that 
 although the difference of weight between the right and 
 left hemispheres is scarcely appreciable,! yet the left 
 frontal lobe is perceptibly heavier than the right ; there 
 would seem, therefore, to be a sort of compensation 
 between the weights of the two frontal and the two 
 occipital lobes, as we have already seen that the right 
 occipital lobe is richer in convolutions, and therefore 
 presumably heavier than the left. 
 
 In a treatise on the brain of man considered from an 
 
 * On the Brains of Criminals, by W. Osier, M.D.— Canada Med. and 
 Surg. Journal, Feb., 1882. 
 
 f According to Dr. Boyd's statistics, which are based on nearly 800 cases 
 observed at the Marylebone Infirmary, the weight of the left hemisphere 
 almost invariably exceeded that of the right by at least the eighth of an 
 ounce. Philosophical Transactions, 1861, vol. 151, p. 241. 
 
 M. Luys examined the brains of 32 adult females from iS to 90 years of 
 age, and his statistics are all the more valuable because the selection was 
 purposely made from subjects entirely free from any cerebral complication 
 during life. Upon these statistics, M. Luys based the following con- 
 clusions. i Q In the normal condition, asymmetry of the two lobes is the 
 rule in the human species ; in the 32 brains examined, he found inequality 
 of the central lobes 27 times. 2° The predominance of the left lobe is the 
 rule ; the left lobe was the largest in more than three-fourths of the 27 
 cases where inequality was observed, the exact proportion being as 78 to 
 22. L'Encephale, No. 4, 188 r, p. 644. 
 
 A more recent observer, Dr. Ireland, in his communication to the 
 Psychological Section of the British Medical Association at Leeds, on the 
 Double Brain and the Discordant Action of the Hemispheres, said that the 
 two hemispheres were unequal in weight, the right being the heavier — 
 contrary to what might be expected, for the left had the most work to do. 
 
WEIGHT OF THE BRAINS OF EMINENT MEN. 367 
 
 anthropological point of view, Professor Nicolucci ob- 
 serves that large brains whilst they remain healthy, are 
 generally the seat of high intellect ; but this rule is not 
 absolute, for brains of ordinary size may be endowed 
 with superior faculties, provided they are well formed, 
 thus proving that the structure and organisation of the 
 brain is more important than its volume and weight.* 
 
 Statistics exist of the weight of the brains of twenty- 
 three eminent men, and the discrepancy observable seems 
 to bear out Nicolucci's views ; for the list is headed by 
 Cuvier the naturalist, whose brain weighed 64^ ounces, 
 whilst that of the orator Gambetta weighed only 39 
 ounces, being 10 ounces below the average weight of 
 the adult male.f Furthermore, the examination of 
 Mr. Grote's head, which was made by Professor Marshall, 
 reveals the fact that the brain of the deceased historian 
 was remarkably small ; it is said, however, to have been 
 rich in convolutions. 
 
 The question of the identity of minute structure in 
 the different cerebral convolutions must now engage our 
 attention. M. Baillarger distinguishes six different layers 
 of nervous substance in the convolutions, and Dr. Lock- 
 hart Clarke says that in most of them at least seven 
 distinct and concentric layers may be distinguished. 
 
 * La Psichiatria, Napoli, 1883, Fasc. 3. 
 
 + I shall have more to say about the brain of ihe great French orator 
 further on ; the report in reference to its weight has led to the publication 
 of an immense number of brain weights. The brains of Abercromby the 
 physician, and of Schiller the Poet, weighed 63 ounces ; Sir James 
 Simpson's weighed 54, Broca's 50, and that of Chalmers 53 ; the brains of 
 Napoleon and Daniel Webster 57 ounces. The heaviest brain on record, 
 which weighed 67 ounces, was that of a bricklayer, who could neither read 
 nor write. 
 
 A 2 
 
368 MINUTE STRUCTURE OF THE CONVOLUTIONS. 
 
 Dr. Clarke says that the other convolutions differ from 
 those at the extremities of the posterior lobes, not only 
 by the comparative faintness of their several layers, but 
 also by the appearance of some of their cells ; he also 
 adds that at the extremity of these posterior lobes the 
 cells of all the layers are small, but on proceeding 
 forward from this point, the convolutions are found to 
 contain a number of cells of a much larger kind ; again, 
 in the insula which overlies the extra-ventricular portion 
 of the corpus striatum, he finds a great number of the 
 cells are somewhat larger, and the general aspect of the 
 tissue is rather different. M. Broca has also studied the 
 minute structure of the cerebral convolutions, and has 
 ascertained that the relative thickness and general dis- 
 position of the six layers recognised by M. Baillarger 
 differ notably in the divers regions ; and although his 
 researches are not definitely terminated, he ventures to 
 assert that the structure of the convolutions of the 
 insula differs from that of the frontal convolutions and 
 of the hippocampus major. 
 
 Vulpian, in his chapter on the anatomical elements of 
 the brain, states that no difference in structure has 
 been discovered in the various regions of the cerebral 
 cortex.* 
 
 Professor Grasset, in the chapter of his classical work 
 on " Diseases of the Nervous System," in which he treats 
 of the structure of the convolutions, says that the dis- 
 tribution of the different elements is not the same in all 
 parts of the brain, and that the 'giant cells' seem to 
 belong only to the motor zone, and that they are met 
 with especially in the ascending frontal and ascending 
 
 * Lecons sur la Physiologie generate et comparee du Systeme Nerveux, 
 p. 649. 
 
MIERZEJEWSKI ON THE BRAINS OF IDIOTS. 369 
 
 parietal convolutions, and in the paracentral lobule. The 
 same writer in his treatise, entitled " Des Localisations 
 dans les Maladies Cerebrates," gives a general summary 
 of our present knowledge of the histology of the cerebral 
 cortex; and in comparing the different regions, he says 
 that the surface of the hemisphere, from a histological 
 point of view, may be divided into two fundamental 
 regions, limited by the furrow of Rolando.* 
 
 Bevan Lewis, whose recent researches are so well 
 known, maintains that there is not only great diversity 
 of structure throughout the various convolutions of one 
 hemisphere, but between the same convolutions in the 
 two hemispheres ; and in writing to me upon this sub- 
 ject, he says that connective over-growth is in his ex- 
 perience more frequent on the left side than on the 
 right ; and that it is a most usual thing to meet with 
 sclerosic states of the left cortex in which the right 
 wholly escapes ; moreover, it is his daily experience to 
 note the great differences in structure due to morbid 
 change between the same convolutions on the two sides ; 
 
 * At the international congress of psychologists held in Paris in 1878. at 
 which I was present, Mierzejewski laid before the meeting the result of his 
 elaborate experiments on the brains of idiots, and the Russian professor's 
 conclusions strongly militated against the notions commonly entertained as 
 to the relative value of grey and white matter in the development of mental 
 force. As the manifestation of the intellectual powers is supposed to be in 
 some way connected with the development of the grey matter of the 
 cerebral convolutions, one would expect to find in idiots a deficiency of this 
 element of brain tissue. Dr. Mierzejewski, who illustrated his communi- 
 cation by casts of the brains o f idiots, showed that this is by no means the 
 case, and he mentioned an instance of an idiot in whose brain the surface 
 of grey matter was enormous. So it would seem that there is no fixed 
 relation between the amount of grey matter of the brain and intellectual 
 power, for richness of grey substance and abundance of nerve cells may be 
 accompanied by idiocy. 
 
370 ON THE DEVELOPMENT OF THE THIRD FRONTAL 
 
 and certainly the third frontat gyrus is no exception to 
 this rule. 
 
 Dr. Broadbent has kindly favoured me with a private 
 communication in reference to his researches as to the 
 course of the fibres of the brain, so far as his observations 
 bear upon our subject. Dr. Broadbent's dissections 
 show that the structure of the third frontal convolution 
 is peculiar, inasmuch as it receives fibres from a greater 
 variety of sources than any other convolution ; and he 
 adds that although this anatomical fact does not throw 
 any particular light on the function of the third frontal 
 convolution, it seems to indicate that it is an important 
 part of the hemisphere. In comparing the two sides of 
 the brain, Dr. Broadbent has usually found the third 
 frontal convolution larger on the left side than on the 
 risfht ; and in the brain of a deaf and dumb woman, he 
 noted that this gyrus was small on both sides, and 
 especially on the left. 
 
 Rudinger has published an essay in which he describes 
 and delineates a series of brains of barristers who were 
 celebrated for their oratorical powers. In all, the third 
 frontal convolution presented a much greater develop- 
 ment than is observed in other classes.* 
 
 Professor Mathias Duval, the Director of the Labora- 
 tory of Anthropology at Paris, has published a detailed 
 description of the external configuration of the brain of 
 Gambetta, which, M. Duval says, 'thanks to the inter- 
 vention of enlightened friends was preserved and studied 
 in the anthropological laboratory.' M. Duval draws 
 especial attention to the fact that the cortical structure 
 of the third left frontal convolution was greatly in 
 excess of that of the opposite side, and in commenting 
 
 * Anatomie des Sprachcentrums, 1882. 
 
CONVOLUTION IN THE BRAIN OF ORATORS. 37 1 
 
 upon this fact he says, 'quelle personalite a jamais 
 represent^ a un plus haut degre" l'orateur improvisateur, 
 le moteur verbal ? ' As Gambetta was gifted with great 
 oratorical powers, the increased growth of cortical tissue 
 in the neighbourhood of the third left frontal convolu- 
 tion has been cited as confirmatory of Broca's theory of 
 the localisation of speech.* 
 
 PHYSIOLOGY. In consequence of the delicate instru- 
 ments of precision now available, the physiology of 
 nerve-tissue furnishes a fertile field of investigation ; still, 
 notwithstanding the great progress which has been made 
 in this direction of late years, our knowledge of the 
 functions of the cerebral cortex is far from complete. 
 What does physiology say to Dax's theory, which has 
 in its favour the undoubted frequency of aphasia with 
 right hemiplegia, as compared with loss of speech as an 
 accompaniment of sinistral paralysis ? This may possibly 
 be explained by the anatomical difference between the 
 origin of the right and left carotids, making the supply 
 of blood to the left side of the brain more direct than 
 that to the opposite hemisphere ; and by increasing its 
 functional activity, thus rendering the left hemisphere 
 
 f L'aphasie depuis Broca, par Mathias Duval, Paris, 1888. This 
 treatise is illustrated by engravings of the right and left hemispheres of the 
 great French orator's brain, and its author suggests that each scientist 
 should leave testamentary direction that his brain should be utilised for 
 scientific purposes after his death. This idea which, M. Duval says, was 
 first promulgated by Bertillon, has rapidly spread in Paris, where a society 
 was formed in 1880, under the title of " La Societe mutuelle d'autopsie," 
 having for its object the utilisation of the brains of its members after their 
 death. This scientific body has received government recognition, and its 
 rules have been approved by a decree of the Prefect of Police of the city of 
 Paris. 
 
372 • PHYSIOLOGICAL CONSIDERATIONS. 
 
 more adapted for the exercise of speech. Emboli, which 
 are so frequent a cause of disturbance of speech, are also 
 much oftener carried into the left common carotid than 
 into the right, from the fact that the former arises from 
 the arch in a line almost exactly coinciding with the 
 course of the blood current, and an embolus would 
 naturally enter this vessel instead of the innominate. 
 
 It would be interesting to know what effect would be 
 produced upon speech by cutting off the direct supply 
 of blood from the left hemisphere. 
 
 On looking over the published cases of ligature of the 
 common carotid artery, I find that one of the earliest 
 instances is one where the left common carotid was tied 
 in 1 815, by Mr. Dalrymple, the well known Surgeon to 
 the Norfolk and Norwich Hospital, for aneurism by 
 anastomosis of the left orbit. In this case speech seems 
 not to have been affected, for it is stated that 'a few 
 minutes after the patient was placed in bed, she declared 
 that her head no longer felt like her old head, as the 
 noise by which she had been so long tormented had now 
 ceased.'* 
 
 Dr. Wm. Ogle quotes a case where the left common 
 carotid artery was tied by Mr. Lee ; the patient died in 
 two days, and in the interval between the operation and 
 his death he was speechless.f 
 
 In the Medico-Chirurgical Transactions for 1859 and 
 1865, are recorded four cases in which the left common 
 carotid was tied by Mr. Nunneley of Leeds ; speech was 
 unaffected in three instances, but in the fourth, great 
 difficulty in speaking was noticed on the sixth day. 
 Since the publication of these cases, Mr. Nunneley has 
 
 * Medico-Chirurgical Transactions, 1815, v. 6. 
 t St. George's Hospital Reports, 1867, p. in. 
 
ON LEFT-HANDED APHASICS. . 373 
 
 tied the common carotid in two other instances, and he 
 writes to say 'in neither of these was there any difficulty 
 in speech, either as regards the idea or the power of 
 utterance.' 
 
 The connection between sinistral cerebral lesions and 
 asemic troubles in the right hand is generally, although 
 not invariably, observed ; and an important question for 
 inquiry is, the frequency of the coincidence of left hemi- 
 plegia with aphasia in left-handed people. Instances of 
 this combination have been recorded by several ob- 
 servers. Dr. Wadham has published the case of a young 
 man of eighteen, who belonged to a left-handed family, 
 as four of his brothers, as well as himself, were left- 
 handed ; a fatal termination having resulted, there was 
 found to be an almost entire absence of the island of 
 Reil on the right side, its place being occupied by a 
 large cavity containing a little fluid and as mall amount 
 of broken-down brain-matter; the left hemisphere was 
 perfectly healthy. In nearly a hundred cases of paralysis 
 with impairment of speech observed by Dr. Win. Ogle, 
 the palsy, except in three instances, was on the right 
 side ; in the three exceptions where the palsy was on 
 the left, all the three persons were left-handed. 
 
 M. Fere, at the Societe de Biologie, at Paris, reported 
 a case of left hemiplegia with aphasia, describing it as 
 simple logoplegia without agraphia, for the patient wrote 
 with the right hand what he was unable to express by 
 articulate language. This case, which at first sight 
 seemed to contradict modern ideas of localisation, in 
 reality confirmed them ; for on inquiry, it was found that 
 the patient was left-handed.* 
 
 « L'Encephale, 1885, No. 4, p. 481. 
 
374 ON DEXTRAL PRE-EMINENCE, 
 
 As a cognate question, I would ask, why are we right- 
 handed ? Is the human race right-handed by mere 
 accident? Although there are a few left-handed people 
 in the world, the immense majority of persons use the 
 right hand for every mechanical act; and man has from 
 time immemorial been considered as a right-handed 
 animal. Is this a question of education or of mere 
 imitation ? If we concede this, we must admit that our 
 ancestors in remote ages must have been influenced by 
 some cause connected with the organisation itself; if it 
 were a mere chance that had determined the choice of 
 the right hand, we should find some left-handed races 
 in certain parts of the world, which, I believe I am right 
 in stating, is not the case. Besides, this question may 
 be set at rest, says M. Broca, by the consideration ' that 
 notwithstanding all their efforts to counteract it, there 
 are left-handed people, who remain left-handed ; and one 
 must, in their case, admit the existence of an inverse 
 organic predisposition, against which imitation, and even 
 education, cannot prevail.' 
 
 Bichat attributes the predominant use of the right 
 hand to our social habits ;* he says that the wants of 
 society render it necessary that a certain number of 
 
 * Ferrier says that why dextral pre eminence should occur in the first 
 instance is not quite satisfactorily made out, but his remarks upon this 
 subject would seem to imply that he shares the views of Bichat, for he says 
 that a person who has lost the use of his right hand, may by education and 
 practice, acquire with his left all the cunning of his right. In such a case, 
 the manual motor centres of the right hemisphere become the centres of 
 motor acquisitions, similar to those of the left. In the same chapter, in 
 speaking of the left articulatory centre as the one commonly and specially 
 educated for speech, he says that there is no reason, beyond education and 
 heredity, why this should necessarily be so. — Functions of the Brain, 2nd 
 edition, p. 451. 
 
WHY IS THE HUMAN RACE RIGHT-HANDED ? 375 
 
 general movements should be executed in the same 
 direction, in order to be generally understood, and by 
 common consent this direction is from left to right. 
 The letters which are employed in writing are thus 
 directed, and this circumstance compels the use of the 
 right hand, which is better adapted for this manner of 
 writing than the left would be.* Dr. Wm. Ogle, in com- 
 menting upon the above explanation, says that Bichat 
 seems to have forgotten, that eastern nations — the Jews, 
 for instance — in writing, move the hand from right to 
 left, and yet are as much right-handed as ourselves. 
 
 Dr. Erlenmeyer, in an essay on the Physiology and 
 Pathology of Writing, states his belief founded upon a 
 passage in the " Talmud," that the ancient Hebrews 
 wrote with the left hand ; and that our use of the right 
 hand is owing to our being taught to write with it, and 
 that the greater use of the right arm determines the 
 predominance of the left side of the brain. The old 
 Hebrews, he says, because they were left-handed, had a 
 better developed and better nourished right brain. Dr. 
 Erlenmeyer also quotes the case of a man, who, from an 
 attack of apoplexy, had hemiplegia of the right side 
 with aphasia ; he could not write with the right hand, 
 and when he was induced to try to do it with the left 
 hand, he wrote very skilfully his name from right to 
 left in mirror-writing, that is writing like the impression 
 on blotting paper, which can be best read by looking at 
 it in a mirror. -J* 
 
 * Recherches physiologiques sur la Vie et la Mort., p. 25, Paris, 1805. 
 
 t Centralblatt fiir Nervenheilkunde, 1880. Dr. Ireland, in commenting 
 upon the reference to the mode of writing of the Hebrews, says that 
 Erlenmeyer is clearly not aware that left-handedness is mentioned as a 
 peculiarity in the Book of Judges, chap. iii. 15 and 16. 
 
37^ ON DEXTRAL PRE-EMINENCE. 
 
 The whole question of dextral pre-eminence is treated 
 in a masterly manner by Dr. Wm. Ogle, who finds the 
 explanation of this phenomenon in the greater weight of 
 the left hemisphere, and in its structural peculiarity of 
 being more highly developed. He gives some very 
 curious statistics about the prevalence of right-handed- 
 ness; of 2,000 consecutive hospital patients, no less than 
 85 were left-handed (4^- per cent). If, says he, the educa- 
 tion hypothesis were correct, one would expect to find 
 that these 85 left-handed persons were the children of 
 left-handed parents, who had trained their offspring in 
 their own peculiarity. This, however, was not the case, 
 as of the whole 85 persons, only 12 had a left-handed 
 parent. He further adds that man is not the only right- 
 handed animal, and that observations made by him on 
 monkeys have convinced him that they, like men, are, 
 as a general rule, right-handed ; of 23 monkeys that he 
 examined at the Zoological Gardens, 20 were right- 
 handed. It will hardly be said that a monkey is dis- 
 ciplined by its parents to use one hand in preference to 
 the other ; and the only conclusion one can draw is that 
 the similar dextral pre-eminence of man and monkey 
 depends on some common fact in their anatomical 
 structure. For these and other reasons, Dr. Ogle con- 
 cludes that the generally held opinion which attributes 
 dextral pre-eminence to educational influence is erroneous; 
 and that right-handedness, though to a certain extent it 
 may be strengthened or modified by education, has some 
 other basis in our bodily confirmation.* 
 
 It would be interesting to ascertain whether any 
 similar difference between the two sides exists with other 
 
 * Medico-Chirurgical Transactions, vol. liv., 1871. 
 
EMBRYOLOGY. 377 
 
 members of the animal kingdom. Aristotle, in alluding 
 to the preferential use of the right hand by the human 
 race, asserted that the right side had a preferential motor 
 function in nearly all the animal creation, and he par- 
 ticularly described the crab as having the right claw 
 distinctly larger and stronger than the left — ndfav yap 
 
 feat icr^vporepa 17 8e£ta. 
 
 At the discussion on aphasia which took place at the 
 meeting of the British Association at Norwich in 1868, 
 Professor Broca alluded to the circumstance that all 
 birds perched on the right leg : Dr. Crisp, on the other 
 hand, said that this peculiarity was confined to Grallae, 
 and he believed it was a question of equilibrium, and 
 that the bird was compelled to take this position from 
 the greater weight of the liver ! Dr. Ogle, who has 
 made repeated observations in birds of various kinds, 
 says that parrots are the only birds in which he has 
 been able to detect with certainty any pre-eminence in 
 one side above the other; of 86 parrots that he tested, 
 63 invariably perched on the right leg. 
 
 The study of Embryology may assist us here. An 
 eminent foreign physiologist, Gratiolet, says that in the 
 development of the brain, the frontal convolutions of 
 the left hemisphere are in advance of those of the right ; 
 and that the left are already properly figured, whilst 
 the right are not yet even visible. Thus, according to 
 Gratiolet, the left hemisphere, which holds in its depen- 
 dence the movements of the right limbs, is more pre- 
 cocious in its development than the opposite hemisphere; 
 and thus the young child uses by preference the limbs 
 of which the innervation is the most complete, or in 
 other words he becomes right-handed. From the cause 
 which thus makes us use the left hemisphere for 
 
378 COMPARATIVE ANATOMY. 
 
 mechanical acts, may arise the circumstance of our using 
 it in preference for speech, and we thus become left- 
 brained — gaiichers du cerveau — to use M. Broca's expres- 
 sion. But is this theory of the early development of 
 the left frontal convolutions true ? Gratiolet says it is ; 
 Carl Vogt, an equal authority, denies it. This is an 
 extremely interesting and important question, about 
 which very few are in a position to give a valid opinion, 
 and I regret I can quote no British authority in reference 
 to it. 
 
 Comparative Anatomy. — Does the study of Com- 
 parative Anatomy throw any light upon our subject ? 
 Here we must inquire whether language be the exclusive 
 prerogative of man ? Some would answer this question 
 in the negative, and M. Lemoine, in the work to which 
 I have already alluded, devotes a chapter to Le Langage 
 des Betes. 
 
 Le Conte, in his " History of China," says of an ape 
 which he saw in the streets of Molucca, that its actions 
 so strongly resembled those of man, and its passions 
 were so lively and significant, that a dumb person could 
 scarcely make himself better understood, or more plainly 
 express his ideas and desires. Mr. Waterhouse described 
 the gibbon's voice as much more powerful than that of 
 any singer ever heard, and the remarkable faculty of 
 imitation and of gesticulations possessed by the ape 
 tribe, together with their power of giving expression to 
 a variety of emotions would seem to imply the possession 
 of a faculty to which one might properly give the name 
 of language ; it is not, however, articulate speech, but 
 merely a form of the general faculty of language of 
 which I have spoken in a preceding chapter. 
 
ON THE LANGUAGE OF ANIMALS. 379 
 
 There is a language springing from the emotions 
 which animals possess in a high degree ; by the vocal 
 sounds of a dog or of a cat, and by the postures 
 and movements that accompany them, we know per- 
 fectly well whether the animal is pleased or angry, 
 frightened or feeling at ease. Darwin tells us that apes 
 utter in anger sounds much resembling interjections, and 
 he mentions the case of a young female ourang made 
 jealous by the attention of a keeper to another ape, and 
 who showed her teeth slightly, and uttered a sulky noise 
 like " tisch-schist," turning her back on him at the same 
 time. This emotional language, man, of course, possesses 
 in common with animals, though, perhaps, not to the 
 same extent as they. 
 
 The parrot has been cited as an instance of the pos- 
 session of rudimentary speech, but this bird only mimics 
 the human voice, because he is endowed with the faculty 
 of imitation to a high degree ; the talk of the parrot 
 is merely an "acoustic reflex." Animals, doubtless, 
 possess the power of expressing their emotions and 
 desires, and of rendering themselves intelligible in their 
 own sphere, but they are destitute of the Xoyoy — the 
 power of uttering a word, which, originating in thought, 
 includes both reason and speech, and which is the 
 peculiar and exclusive prerogative of Man. 
 
 In my treatise on " Darwinism tested by Language," 
 I have entered at great length into the Question of the 
 language of animals, and I have endeavoured to show 
 that Articulate Speech is a distinctive attribute of man ; 
 that the ape and lower animals do not possess a trace of 
 it, and that it furnishes the difference of kind between 
 man and animals which Mr. Darwin asserted did not 
 exist. 
 
380 COMPARISON BETWEEN THE BRAIN OF 
 
 Max Miiller, speaking of this subject, says, ' Speech is 
 a specific faculty of man. It distinguishes him from all 
 other creatures ; and if we wish to acquire more definite 
 ideas as to the real nature of human speech, all we can 
 do is to compare man with those animals that seem to 
 come nearest to him, and thus try to discover what he 
 shares in common with these animals, and what is 
 peculiar to him, and to him alone.' Further on he says, 
 ' Language is something more palpable than a fold of 
 the brain or an angle of the skull ; it is the one great 
 barrier between the brute and man ; it admits of no 
 cavilling, and no process of natural selection will ever 
 distil significant words out of the notes of birds or the 
 cries of beasts. Language is our Rubicon, and no brute 
 will dare to pass it. J 
 
 One of the differences between man and the more 
 intelligent animals is in the degree of development of 
 the cerebral convolutions, which, moreover, exist only in 
 the class Mammalia ; and according to Flourens, the 
 Rodentia, the least intelligent of the Mammalia, have no 
 convolutions; the Ruminantia, more intelligent than the 
 Rodentia, have convolutions ; the Pachydermata, who 
 are still more intelligent than the Ruminantia, possess 
 still more convolutions ; and so on the number continues 
 to increase as we ascend to the Carnivora, then to the 
 Apes, the Orangs, and lastly to Man, who is the richest 
 of all animals in cerebral convolutions. 
 
 A more recent naturalist, Professor Huxley, says that 
 in the lower and smaller forms of placental Mammals, 
 the surface of the cerebral hemispheres is either smooth 
 or evenly rounded, or exhibits a very few grooves, which 
 are technically termed sulci ; and the smaller species of 
 all orders tends to a similar smoothness of brain. In the 
 
MAN AND THAT OF ANIMALS. 38 1 
 
 higher orders, the grooves become extremely numerous, 
 and the intermediate convolutions proportionately more 
 complicated in their meanderings, until, in the Elephant, 
 the Porpoise, the higher Apes, and Man, the cerebral 
 surface appears a perfect labyrinth of tortuous foldings. 
 
 If this gradation in the number of the convolutions 
 has a relation to the intelligence of the animals, it would 
 seem to give an a priori reason for concluding that the 
 highest product of intelligence — speech — may well have 
 some connection with the development of the convolu- 
 tional grey matter. 
 
 As the researches of naturalists all tend to establish a 
 physiological homology of the brain of man with that of 
 the ape — for both are constructed on the same type, and 
 contain essentially the same primary fissures and con- 
 volutions — let us consider for one moment the comparison 
 which Carl Vogt makes between our quadrumanous 
 cousins and ourselves. According to this distinguished 
 naturalist, the Apes have an extremely imperfect de- 
 velopment of the third frontal convolution, and the same 
 condition exists in the Microcephali ; therefore, he says, 
 as neither Apes nor Microcephali can speak, Comparative 
 Anatomy gives a subsidiary support to the theory which 
 places speech in this convolution. Professor Vogt's 
 views seem to me of such great importance, and so 
 extremely pertinent to our subject, that I shall give 
 them in his own words. 
 
 The brain of Man and that of Apes, especially of the anthropoid 
 apes (Orang, Chimpanzee, Gorilla), are constructed absolutely upon 
 the same type — a type by itself — and which is characterised, 
 amongst other things, by the fissure of Sylvius and by the manner 
 in which the island of Reil is formed and covered,* but there are 
 
 * The island of Reil, so often injured in affections of speech, is an im- 
 
382 THE COMPARATIVE DEVELOPMENT OF THE 
 
 secondary differences in the arrangement of the folds, and in the 
 comparative development of the lobes and of the convolutions. 
 
 One of the principal characters is, that in the brain of all the 
 human races, without exception, the frontal lobe, by its posterior 
 and inferior part (that is in Broca's region) touches the temporo- 
 sphenoidal lobe, so as to give to the fissure of Sylvius with its two 
 branches, the appearance of a double-pronged fork ; whilst in the 
 Ape, Broca's convolution is separated from the temporo-sphenoidal 
 lobe by the lower end of the transverse frontal and transverse 
 parietal convolutions ; in other words, in Man, the third frontal 
 convolution is extraordinarily developed and covers partly the 
 insula, whilst the transverse central convolutions are of much less 
 importance ; in the Ape, on the other hand, the third frontal con- 
 volution is but slightly developed, whilst the central transverse 
 convolutions are very large, descending quite to the edge of the 
 hemisphere, and giving to the fissure of Sylvius the form of a V. 
 The cause of this difference dates from the period of embryonic 
 development : — the brain of the foetus of any of the Mammalia at a 
 certain age (two months in Man), has the form of a bean with a 
 large infero-lateral sinus corresponding to the insula and the sur- 
 rounding parts. From the third to the fifth month, this large space 
 becomes covered in Man by the very rapid growth of the third 
 frontal convolution, and by the slow growth of the transverse 
 central convolutions ; whilst in the Ape, it is just the reverse, the 
 space is filled by the rapid growth of the transverse central con- 
 volutions, and by the slow growth of the third frontal convolution.* 
 
 portant characteristic of the human brain. It may be said really to exist 
 in no other mammifer ; it is true the monkey has one, but it is quite 
 smooth, scarcely offering a trace of a fold in the higher apes, such as the 
 orang and the troglodytes. Gratiolet — Anatomie Compare du Systeme 
 Nerveux, torn, ii, p. in. 
 
 * Professor Hartmann, of Berlin, does not agree with the above state- 
 ment as to the imperfect development of the third frontal convolution in 
 the Ape, for he says, ' Far from being feebly developed in the Chimpanzee, 
 the Orang, and the Gibbon, or even entirely absent in most of the other 
 apes, as asserted by Bischoff, the third frontal convolution is well developed 
 in the apes. The most striking feature in the structure of these animals is 
 the shortness of the corpus callosum.' — Les Singes anthropoides et leur 
 organisation comparee a celle de l'homme, 1886. 
 
THIRD FRONTAL CONVOLUTION IN MAN AND APE. 383 
 
 To show the bearing all this has upon the seat of speech, I would 
 refer to the Microcephali who do not speak — they learn to repeat 
 certain words like parrots, but they have no articulate language. 
 Now, the Microcephali have the same conformation of the third 
 frontal convolution and of the central folds as Apes — they are Apes 
 as far as the anterior portion of their brain is concerned, and 
 especially as far as regards the environs of the fissure of Sylvius. 
 Thus, Man speaks ; Apes and Microcephali do not speak ; certain 
 observations have been recorded which seem to place language 
 in the part which is developed in Man and contracted in the 
 Microcephali and the Ape ; comparative anatomy, therefore, comes 
 in aid of M. Broca's doctrine.'* 
 
 I have reason to believe that these views of Professor 
 Vogt are not very generally known in this country, and 
 I need hardly allude to the extremely important bearing 
 they have upon the question at issue. With the view 
 of obtaining some confirmation of the statement of the 
 arrest of development in the third frontal convolution of 
 the microcephali, I have consulted Mr. Marshall's ex- 
 tremely interesting paper in the Philosophical Trans- 
 actions for the year 1864, in which he gives a detailed 
 description of the frontal convolutions of a microcephalic 
 woman and boy, neither of whom possessed the power 
 of articulation. In both these brains, the frontal con- 
 volutions are described as being singularly short and 
 defective, as compared with their wonderfully tortuous 
 and complex character in the perfect brain ; in fact, 
 Mr. Marshall adds that they were far more simple than 
 in the orang's or the chimpanzee's brain. In only one 
 
 * The above is an extract from an autograph letter with which Professor 
 Vogt has favoured me. In this communication, he expresses a doubt 
 whether we shall ever be able satisfactorily to assign "the divers functions " 
 which compose language, to special parts of the brain, until we have a 
 physiological analysis of articulate language, similar to that which 
 llelmholtz has given of sight and hearing. 
 
 B 2 
 
384 EXPERIMENTS ON THE BRAIN OF ANIMALS ; 
 
 of these microcephalic brains, however, was the want of 
 development most apparent in the third frontal convolu- 
 tion. Further investigations would, therefore, seem 
 necessary before admitting with Carl Vogt that the con- 
 formation of the microcephalic brain gives a direct 
 support to the localisation of speech in the third left 
 frontal convolution. 
 
 Experimental pathology, of course, cannot supplant 
 clinical observation, but it may lead us to clearer scientific 
 notions of the nature of disease. M. Bouillaud, so well 
 known for his elaborate researches by means of experi- 
 ments on animals, obtained certain results, which, al- 
 though not proof against criticism, or directly useful in 
 the treatment of disease, yet as the outcome of methodi- 
 cal scientific inquiry, must be considered as valuable 
 contributions to the physiology of the nervous system. 
 
 As far back as 1827, M. Bouillaud instituted a series 
 of experiments upon animals, with the view of deter- 
 mining the functions of the brain, and on several 
 occasions he removed different portions of the cerebral 
 lobes, without impairing sight or hearing ; he also re- 
 moved the entire hemispheres from a chicken, in which 
 the power of expressing pain by its peculiar cry was 
 retained.* On one occasion he pierced with a gimlet 
 the anterior part of the brain of a dog, from side to side, 
 at a spot corresponding to the union of the anterior with 
 the middle lobes — that is in the immediate neighbour- 
 hood of Broca's region. The dog survived the mutilation, 
 but was much less intelligent than before the operation, 
 
 * Recherches experimentales sur les fonctions du cerveau. Journal de 
 Phjsiologie, torn, x., p. 49. 
 
BOUILLAUD, IIITZIG, FERRIER, AND GOLTZ. 385 
 
 and although he could utter cries of pain, he had 
 entirely lost the power of barking.* 
 
 The recent researches of Hitzig and Ferrier indicate 
 the region of the third frontal convolution and the 
 insula as the motor centre for the tongue and lips. 
 Duret has twice extirpated this region in dogs, in order 
 to see if phenomena would arise analogous to those 
 observed in man after lesion of the third frontal con- 
 volution ; in both instances the dogs seemed to have 
 lost the power of barking. Goltz, of Strassburg, on the 
 other hand, maintains that dogs, whose pretended barking 
 centres are destroyed, can still bark, howl, and growl ; in 
 fact, can give phonetic expressions of their feelings in 
 many different ways. 
 
 As far as the present inquiry is concerned, I am aware 
 that but little importance can be attached to these ex- 
 periments, for there is little or no analogy between the 
 cry of a chicken or the bark of a dog, and the articulate 
 speech of man ; animals that express their feelings by 
 screaming, crowing, croaking, &c, are still able to utter 
 these sounds after their brain, up to and including the 
 corpora quadrigemina, has been removed. Furthermore, 
 the celebrated " croaking experiment " of Goltz shows 
 that a frog, as long as it possesses a brain, does not as a 
 rule croak when the back is stroked ; as soon, however, 
 as the cerebrum is cut away above the corpora quadri- 
 gemina, every soft stroking of the back evokes a croak. 
 
 Although the results of different experimentalists upon 
 the brain of animals have been various and contradictory, 
 still, experiments of this kind may have an indirect 
 bearing upon our subject, and it would be extremely 
 
 * Op. cit , p. 85. 
 
386 THE BRIDGING CONVOLUTIONS. 
 
 interesting to know what would be the effect of traumatic 
 injury to certain regions of the anterior lobes upon the 
 quasi-articulatory powers of the parrot. 
 
 I think that much valuable information in reference 
 to the seat of speech may be elicited from a more care- 
 ful study of the affinities and differences between the 
 brain of man and that of animals ; but this study, surely, 
 should not be confined to the convex surface, or even 
 to the anterior half of the hemisphere. Professor 
 Rolleston, in a most interesting paper, has called atten- 
 tion to other points of difference between the brain of 
 man and that of apes, and he attaches a great physio- 
 logical value to the presence or absence of the " bridging 
 convolutions" which more or less fill up the space known 
 as the external perpendicular fissure, which separates 
 the occipital from the parietal lobe.* 
 
 Professor Owen mentions the superior development of 
 the hippocampus minor, as a point of distinction be- 
 tween man and the lower animals. According to him, 
 in the inferior mammalia the posterior cornu of the 
 lateral ventricle is capacious and simple ; whereas in the 
 chimpanzee and gorilla, the growing walls begin to be 
 reduced by the encroachment of a protuberance, which 
 in the archencephala is developed into the hippocampus 
 minor.-(- It will be remembered that it was in this 
 lesser hippocampus that Dr. Barlow formerly located the 
 faculty of speech. 
 
 * Medical Times, Feb. 22nd and March 15th, 1862. There are many 
 other points in Dr. Rolleston's paper, which, although having no direct 
 bearing upon speech, afford a collateral aid to that subject, and it is im- 
 possible to overrate the value of the talented Oxford Professor's researches 
 in this direction. 
 
 t Comparative Anatomy and Physiology of the Vertebrates, vol. iii., 
 p. 138. 
 
GRATIOLET'S DIVISIONS OF THE HUMAN RACE. 387 
 
 Anthropology. The comparative facility of speech 
 in different races of mankind is an interesting point to 
 notice, and it is much to be regretted that we possess so 
 little authentic information upon this subject. Let us 
 consider what variations are observed in the morphologi- 
 cal characters of the brain in different branches of the 
 human family. 
 
 Gratiolet has established three principal divisions of 
 our species under the names of Frontal or Caucasian, 
 Parietal or Mongolian, and Occipital or Ethiopic. He 
 has shown that in the Caucasian, the anterior fontanelle 
 is the last to ossify, in order to permit of the greatest 
 possible development to the frontal lobes ; and that in 
 the Ethiopic race the converse condition exists, the 
 posterior fontanelle being the last to ossify. According 
 to this arrangement, in the superior races, the frontal 
 lobes of the hemispheres continue to develop themselves 
 for a long time after the occlusion of the posterior sutures 
 has put an end to the growth of the rest of the brain ; 
 in the inferior races, on the contrary, the ossification of 
 the sutures proceeds from before backwards, and thus 
 the anterior parts of the brain are first arrested in their 
 growth. 
 
 Barnard Davis, whose craniological researches have 
 rendered such immense service to anthropological science, 
 says that the cranium is subject to variations of size and 
 of form, almost endless in the different races of man ; 
 and that these diversities are coincident with and allied 
 to disparities of powers, capacities, and character, which 
 may be considered to a certain extent commensurate 
 with the differences of conformation themselves. In 
 treating of the synostosis of the cranial bones, he adds 
 that the premature obliteration of the sutures is of the 
 
388 THE CRANIOLOGICAL RESEARCHES OF BROCA, 
 
 utmost importance in craniology; its tendency being to 
 change the natural shape of the calvarium, and thus pre- 
 vent the further development of the brain. He places 
 the skull of the Australian in a category which is 
 characterised by under-sized and ill-developed brains, 
 narrow and low anterior lobes, manifested in crania of 
 small capacity, of little elevation, contracted and recedent 
 in the frontal region, with generally a large amount of 
 osseous matter in their composition* 
 
 M. Broca, the founder of the Paris Anthropological 
 Society, whose ethnological researches are so well known, 
 directed his attention principally to that branch of 
 anthropology which treats of the physical characters of 
 the different human races ; and from his craniometrical 
 observations, aided by the various instruments that he 
 invented, comparative craniology has acquired an exacti- 
 tude and precision equal to any other branch of com- 
 parative anatomy. 
 
 In a progressive civilisation, such as prevails through- 
 out the greater part of Europe and America, there is 
 reason to suppose that the cranial capacity of the popu- 
 lation is, upon the whole, increasing. Owing to the want 
 of early observation, it is difficult to institute comparisons 
 between the past and present ; an opportunity, however, 
 occurred in Paris a few years ago, which was taken 
 advantage of by M. Broca, who has given the result of 
 his examination of 384 skulls exposed in excavations 
 made in Paris ; they were divided into three series, one 
 corresponding to a period antecedent to the 12th century, 
 a second to the 16th, and a third to the 19th century. A 
 comparative study of these skulls showed that the average 
 
 * Crania Britannica, vol. i., pp. 231, 233, 235. 
 
EARNARD-DAVIS, FLOWER, AND THE ABBE FRERE. 389 
 
 cranial capacity had increased during seven or eight 
 centuries by miore than 35 centimetres, the increase being 
 almost exclusively in the frontal regions. Of the 125 
 skulls of the 19th century series, by noting the place of 
 burial and other circumstances, a distinction could be 
 made between the rich and the poor, disclosing an average 
 difference of 80 cubic centimetres in favour of the former — 
 la classe aisee.* 
 
 That the increase in cranial capacity has gone on 
 slowly but surely, as man has progressed from barbarism 
 to civilisation, may be inferred from a study of the cranial 
 capacities of the various human races ; thus, while the 
 brain capacity of the European amounts to 94 cubic 
 inches, it is stated to be only 91 in the Esquimaux, 85 in 
 the negro, 82 in the Australian,"!" and 77 in the Bushman. 
 Thus, civilisation, by giving increased exercise to the 
 brain, has, there is good reason to believe, gradually 
 produced that increase of brain capacity which now dis- 
 tinguishes the civilised from the savage races of man- 
 kind. I 
 
 * Broca— Sur la capacite des cranes Parisiens des diverses epoques. 
 Bulletins de la Societe d'Anthropologie, 1862. 
 
 t According to Professor Flower, metopism or permanent opening of 
 the frontal suture is rare in Australians ; in iqo Australian skulls examined, 
 it was not open in one instance. Dr. Flower adds that the Australian 
 resembles the anthropoid apes, amongst which metopism is rare. 
 
 J A few years ago a controversy was carried on, in which Professor 
 Flower, Dr. Kesteven, Mr. Hyde Clarke, and others took part, in reference 
 to the size of heads, and it was asserted that a sensible diminution had taken 
 place of late years in the size of the heads of the male population of these 
 islands ; the data upon which this startling statement was founded, were 
 supplied by the most persistent, if not the most scientific, class of head 
 measurers — the hatters. Numerous letters upon this subject appeared in 
 " Nature," and one manufacturer of hats wrote to say that heads generally 
 
390 IS THE CRANIAL CAPACITY INCREASING 
 
 I am aware that there is another side to this question, 
 for there exists a widely spread opinion that modern 
 civilisation and social pressure, arising mainly from the 
 extraordinary scientific discoveries of the closing decades 
 of the nineteenth century, are actually causing degenera- 
 tion of brain power, as shown by the fact that insanity 
 and neuroses are on the increase ; this, although a matter 
 of vital importance, is a question of cerebral hygiene, to 
 which I can only make an incidental allusion. This 
 idea, however, is not new, for the ancients, instead of 
 
 are two sizes less than they were thirty or forty years ago, and that a head 
 of more than 24 inches in circumference is now quite a rarity, whilst 
 thousands of hats are made for heads with a circumference of about 21 
 inches. Professor Struthers, of Aberdeen, who has kindly favoured me 
 with information upon this interesting point, very justly remarks that 'the 
 hat is not an infallible test, as it does not mark the height of the head.' 
 
 If, however, as seems probable, hats, on the whole, are smaller than they 
 were a generation ago, I cannot think it justifies the inference that the 
 cranial capacity has diminished ; but the fact is rather to be explained by a 
 change of fashion, and the mode of wearing both hat and hair. Thirty 
 years ago, it was customary to wear the hat well drawn down over the 
 head, covering the occiput and ears, and the hair was worn long and thick. 
 I think these two causes will more adequately explain the decrease in the 
 size of hats, rather than the supposition that the heads of the male popula- 
 tion have sensibly diminished — a theory quite at variance with the notions 
 of recent anthropological science, which tells us that with a progressive 
 civilisation, such as prevails through the greater part of Europe and 
 America, there is reason to believe that the cranial capacity of the popula- 
 tion is, on the whole, increasing rather than diminishing. 
 
 A theory as old as Herodotus assumes that the thickness of the skull 
 depends upon the use or otherwise of head coverings. In his description 
 of the battle of Pelusium, Herodotus says : — The bones of the slain lie 
 scattered upon the field in two lots, those of the Persians in one place by 
 themselves, those of the Egyptians in another place. If you strike the 
 Persian skulls, even with a pebble, they are so weak, that you break a hole 
 in them ; but the Egyptian skulls as so strong, that you may smite them 
 w'th a stone and you will scarcely break them in. The natives assigned as 
 
WITH THE PROGRESS OF CIVILISATION? 39I 
 
 believing in perpetual progress, maintained that humanity 
 was always deteriorating, and, strange to say, in propor- 
 tion to the progress of civilisation ! This notion seems 
 to have pervaded the minds of legislative reformers, his- 
 torians, and poets ; and Horace made himself the echo 
 of the common opinion when he said : — 
 
 " Damnosa quid non imminuit dies ? 
 ^Etas parentum pejor avis tulit 
 Nos nequiores, mox daturos 
 Progeniem vitiosiorem." 
 
 Livy, Tacitus, and other writers, up to the fall of the 
 Roman empire, seem to have confirmed the general 
 opinion of the progressive deterioration of the human 
 family. 
 
 The important researches made in reference to ancient 
 skulls by the Abbe Frere, whose rich collection is in the 
 anthropological museum at Paris, led him to the con- 
 clusion that the skulls of Europeans have increased in 
 size since historic times ; and that the progress of civilisa- 
 tion seems to have resulted in raising the anterior, and 
 flattening the occipital part of the skull. I recommend 
 the data of the Abbe Frere to the especial consideration 
 
 a reason for this difference, that the Egyptians from early childhood have 
 the head shaved, and so by the action of the sun, the skull becomes thick 
 and hard. The same cause prevents baldness in Egypt, where you see 
 fewer bald men than in any other land. Such then is the reason why the 
 skulls of the Egyptians are so strong. The Persians, on the other hand, 
 have feeble skulls, because they keep themselves shaded from the first, 
 wearing turbans upon their heads. 
 
 Sir G. Wilkinson, in commenting upon the above passage, says that the 
 thickness of the Egyptian skulls is observable in the mummies ; and that 
 those of the modern Egyptians fortunately possess the same property of 
 hardness, to judge from the blows they bear from the Turks, and in their 
 combats among themselves. 
 
392 ANTHROPOLOGY, AND ITS USE TO THE 
 
 of Professor Max Miiller and others who are engaged in 
 the great controversy of the evolution of language. 
 
 The tardy occlusion of the anterior sutures, as stated 
 by Gratiolet, tends to prove that the development of the 
 higher faculties of the intellect is in relation with the 
 development of the anterior region of the skull ; and 
 that the frontal lobes form the substrata of those 
 psychical processes which lie at the foundation of the 
 higher intellectual operations. With the view of verifying 
 the accuracy of this theory, M. Broca examined the 
 heads of thirty-two house-surgeons who had successively 
 resided at Bicetre during the years 1861 — 1862, and 
 compared their dimensions with those of the heads of 
 twenty-four porters attached to the various wards of the 
 same hospital. This comparison resulted in the con- 
 firmation of the generally received opinion, that 
 the anterior lobes are the seat of the highest order of 
 intellectual faculties ; and M. Broca considered that he 
 had demonstrated that the cultivation of the mind and 
 intellectual work augment the size of the brain, and that 
 this increase chiefly affects the anterior lobes. 
 
 This predominance of the anterior lobes over the rest 
 of the brain, has, of course, an indirect connection with 
 the disputed question of the localisation of the faculty of 
 articulate language. 
 
 Anthropology is calculated to render great service to 
 the student of the science of language, for the study of 
 this branch of knowledge is not limited to anthropo- 
 metrical observations, compiling statistics, or collecting 
 skulls, but anthropological research embraces all facts 
 bearing upon the evolution of the human species; and if 
 it be true that simplicity in the arrangement of the con- 
 volutions of the brain is a mark of structural inferiority, 
 
STUDENT OF THE SCIENCE OF LANGUAGE. 393 
 
 that a want of symmetry between the convolutions of 
 the two hemispheres is one of the signs of intellectual 
 superiority, that premature obliteration of the sutures 
 is common in the inferior races, it would be extremely 
 interesting to notice the relation between these characters 
 and the degree of facility of speech in the different races 
 of mankind. 
 
 Having now considered the subject of speech, its loss, 
 and its localisation, in all its various phases and aspects, 
 I would observe that I am aware that my remarks may 
 be said to be of an iconoclastic character. I may be 
 told that I have set up the authors of the four popular 
 theories for the mere pleasure of knocking them down 
 again, without substituting any theory of my own in 
 their place. 
 
 In reference to these doctrines, the truth and value of 
 which I have called in question, it is no fault of mine if 
 the pedestals upon which they stand are rotten ; and 
 that certain stubborn facts stand in the way of their 
 unreserved acceptance. In lieu of offering any hypothesis 
 myself as to where the cerebral centre for speech may 
 be, I would ask, Is it certain that there is a cerebral 
 centre for speech at all ? When we talk of the "faculty 
 of speech" have we any very clear and definite notions 
 as to what we mean ?* May not speech be one of those 
 
 * Dr. Maudsley denies the existence of a speech faculty, and says, 
 ' There is no more a special faculty of speech in the mind than there is a 
 special faculty of dancing, or of writing, or of gesticulating. All the volun- 
 tary movements of the body may be called the outward expressions of ideas. 
 The movements of the tongue have not a special kind of connection with 
 the mental processes, although the connection is an intimate one. If a 
 person be dumb, he must use the muscles of some other part of the body 
 to express his ideas.' 
 
394 ON THE FROZEN CEREBRUM OF ANIMALS. 
 
 attributes, the comprehension of which is beyond the 
 limits of our finite minds ; and may it not be dependent 
 upon a nescio quid which the knife of the anatomist 
 cannot reveal, and the test-tube of the chemist is unable 
 to detect ? If the outward manifestation of this innate 
 faculty is connected with certain definite organic con- 
 ditions, it is not logical to confound these conditions 
 with the faculty itself. Does the loss of it necessarily 
 imply organic lesion of structure? If it were so, how 
 can we account for the instances I have quoted, in which 
 the restoration of the power of speech was due to the 
 effect of a severe mental shock ? Intemporary aphasia, 
 there is evidence of some fugacious affection of the 
 cerebral substance, such as congestion, anaemia, molecular 
 changes from psychical excitement* or from atmospheric 
 or other influences with which we have little or no 
 acquaintance ; in fact, the literature of aphasia furnishes 
 abundant evidence to prove that great emotional excite- 
 ment, a moral shock, a rush of blood to the head, a 
 rapidly developed ischaemia of the brain, such as is apt 
 to occur in affections of the heart and in arterial sclerosis, 
 are sufficient to produce disturbance of speech. 
 
 The brilliant experiments of Dr. Richardson, of freezing 
 the cerebrum of animals, which it has been my privilege 
 to witness, conclusively show that various cerebral 
 functions may be temporarily but completely suspended, 
 without leaving any trace of organic mischief. In some 
 lower animals, such as frogs, the nervous centres can be 
 
 * A remarkable illustration of molecular change is given by Fournie, 
 who, in speaking of the movements of matter, says that the blow of a 
 hammer on a bar of steel gives rise to a sonorous movement and to caloric, 
 the caloric to electricity, and the electricity to light. Physiologie de la 
 voix et de la parole, Paris, 1886. 
 
REFRIGERATED FROGS. 395 
 
 frozen for long periods, with recovery after entire uncon- 
 sciousness and apparent death ; these refrigerated frogs 
 do not respire during insensibility, and whilst in that 
 state can be placed without harm in gases which, under 
 ordinary circumstances, would not support life. Dr. 
 Richardson has thus placed animals in hydrogen, 
 nitrogen, and carbonic acid. In one experiment, when 
 the animal was frozen, it was immersed in ether, the 
 temperature of which was not sufficient to thaw the 
 animal ; after the complete abolition of all the functions 
 and the cessation of respiration, if the thawing process 
 was conducted with precautions, the animals revived 
 completely. I confidently predict that the question of 
 the localisation of our different faculties is destined to 
 receive considerable elucidation from Dr. Richardson's 
 valuable researches. 
 
 The late Dr. J. T. Dickson has recorded an experiment 
 on a pigeon, whose brain was frozen while the bird was in 
 the act of eating oats. The impression of feeding was 
 evidently frozen on the brain cells, for the moment the 
 brain was thawed, the bird again began to peck as though 
 feeding, although the floor was bare. Dr. Dickson cited 
 the above experiment as illustrative of his views of the 
 " Potentiality of Vitality." It is very evident that there 
 could have been no structural change in the nerve 
 elements of the animals submitted to these experiments, 
 and whose functions were temporarily suspended ; and it 
 is equally clear there could be no organic change in the 
 brain of many of the patients mentioned in the previous 
 pages, and who were the subjects of transitory aphasia.* 
 
 * General cerebral pathology may receive considerable aid fiom the 
 study of insanity, which in many cases cannot be traced to any visible and 
 palpable lesion of the brain, and is then essentially a psychological phe- 
 
396 ACTION OF CHLOROFORM ON NERVE TISSUE. 
 
 It has occurred to me to inquire whether during the 
 anaesthesia produced by the inhalation of chloroform, 
 there is any altered structural state of the cerebral tissue, 
 which would be patent to our senses, supposing we 
 were in a condition to make the necessary examination. 
 From experiments lately made in Paris by Dr. Ferraud, 
 it would seem that the action of chloroform on the 
 cerebral nerve tissue is direct by means of the olfactory 
 nerves, and that the production of the anaesthetic con- 
 dition does not necessitate the passage of the drug into 
 the arterial system by means of the pulmonary mucous 
 membrane.* 
 
 nomenon. E-quirol, one of the greatest authorities, goes so far as to say 
 i° that organic lesions of the brain and of its membranes are in general 
 only observed in complicated cases ; 2° that all the lesions observed in 
 lunatics are often found in those who have not lost their reason ; 3° that in 
 a large number of cases, the brain of lunatics presents no appreciable altera- 
 tion whatever, although the mental derangement may have lasted for many 
 years ; in support of his views, this writer asks how sudden cures of insanity 
 can be explained, on the hypothesis of an organic lesion. Doubtless it may 
 be said that Esquirol lived at a time when only the gross morphology of the 
 brain was studied ; but with all the facilities for investigation now available, 
 alienists of the present day are obliged to admit that in many, if not in 
 most cases, the cause of mental derangement does not reveal itself in any 
 structural alteration of the brain. 
 
 * I am aware that the above conclusions have been disputed by other 
 physiologists (Dieulafoy and Krishaber). M. Ferraud's experiments, 
 however, seem to me to be conclusive ; having opened the trachea in 
 rabbits, he introduced a tube, and then divided the trachea above ; a small 
 cupping glass, containing a sponge imbibed with chloroform, was then 
 placed over the nose of the rabbit ; in three minutes the anaesthetic con- 
 dition was produced, and maintained as long as the olfactory apparatus 
 was submitted to the action of chloroform. When the same animal was 
 chloroformed by means of the tracheal tube and the respiratory apparatus, 
 anaesthesia was produced a little sooner [i.e., by 15 seconds) than when the 
 anaesthetic was administered by the olfactory apparatus. Gazette des 
 Hopitaux, May 29 1869. 
 
EACH BRAIN CELL A MINUTE VOLTAIC BATTERY. 397 
 
 May not loss or lesion of speech depend on some 
 altered state of the cerebral tissue not appreciable to the 
 sense of vision — to the eye — for microscopic examination 
 is only the aided eye ? Without doubt, there may be 
 changes going on in nerve tissue which escape our means 
 of investigation, and I am supported in this view by one 
 of the greatest continental histologists, who, in con- 
 versing with me about softening of the brain, said that 
 he believed there were changes of structure not revealed 
 by the microscope, but which were patent to the sense 
 of touch. I find that Dr. Sankey is of the same opinion, 
 for he thinks the altered specific gravity of the brain in 
 old people indicates that the nerve tissue has undergone 
 some change of structure which the microscope has not 
 yet made palpable to our vision.* The nutrition of the 
 organ in such cases is doubtless in some way disturbed, 
 but the alteration is too fine for detection by the aid of 
 our present means of investigation. 
 
 The fact of the occasional benefit obtained from the 
 use of electricity in impaired speech, as observed by 
 Dr. Marcet and others, would lead to the inference that 
 the defect may depend in some instances upon an altered 
 electrical condition — upon some dynamic change and 
 altered polar arrangement of the ganglionic cells. ' It 
 may be,' says Dr. Beale, 'that each little brain cell with 
 its connected fibres, in some way resembles a minute 
 voltaic battery with its wires ; the matter of which the 
 cell is composed undergoing chemical change, in the 
 course of which slight electrical currents are developed ; 
 these being transmitted by the fibres ramifying to 
 
 * On the state of the Small Arteries and Capillaries in Mental Disease. 
 Journ. Ment. Science, Jan., 1869. 
 
39 8 ON CEREBRAL THERMOMETRY. 
 
 different parts, exert an influence upon tissues and 
 organs amongst which they ramify.'* 
 
 Some physiologists consider epilepsy to be the result 
 of a sudden, temporary, and excessive discharge from 
 some highly sensitive region of the cerebral cortex — the 
 discharging lesion being a group of cells whose instability 
 is raised above normal. 
 
 May not some thermal change, the result of chemical 
 action, interfere with the exercise of speech ? In the 
 section on diagnosis, I have already alluded to cerebral 
 thermometry ; it is extremely probable that some thermal 
 change in the brain may account for disturbance of 
 speech, quite irrespective of any structural alteration, for 
 the part which temperature plays in the circle of morbid 
 action has not been fully recognised. Much, however, 
 has been done in this direction of late years, although 
 doubt has been expressed as to whether the temperature 
 of the scalp affords any correct indication of the cerebral 
 temperature, notwithstanding the elaborate instruments 
 that have recently been invented. 
 
 In the Centralblatt der med Wissenschaft, No. 27, was 
 an account of experiments made by Dr. Maragliani of 
 Genoa on the dead body, in order to ascertain whether 
 the temperature within the cranium is correctly indicated 
 through the thermometer laid upon the scalp. Having 
 placed his instruments on different parts of the shaved 
 head, he then introduced another within the skull, the 
 cavity of which was filled with hot water. He then 
 found on comparing the temperature of the outer 
 and inner thermometers, that within half an hour the 
 difference was about two degrees. He also observed 
 
 * Lectures on the Germinal or Living Matter of Living Beings. Medical 
 Times, July 10, 1869. 
 
CHEMICAL COMPOSITION OF THE BLOOD. 399 
 
 that iii many cases the temperature of the head was 
 found to be higher than that of the axilla, showing that 
 the brain has a heat independent of the general tem- 
 perature. Mental activity, age, and sex, he added, have 
 a marked influence upon the temperature of the brain. 
 He also found that to obtain correct results, it was often 
 necessary to prolong the observation for an hour. 
 
 Certain chemical changes may take place in the brain 
 substance which imply a departure from healthy physio- 
 logical action, and, in consequence of these changes, 
 there is a more or less prolonged retention in the blood 
 of some product which ought to be eliminated. 
 
 I am glad to find that the study of the chemical com- 
 position of the blood, as a factor in nervous diseases, has 
 not escaped the attention of Dr. Bevan Lewis, who, in 
 his recently published work, says that 'a diminution in 
 haemoglobin is clearly indicated in all cases of general 
 paralysis examined. The corpuscular richness varied 
 considerably — in fact, from 75 to 126 per hcemic unit, 
 the higher register pertaining to cases where maniacal 
 excitement prevailed. No connection is established, 
 however, between mania and such corpuscular richness, 
 since a diminution in the number of red corpuscles is 
 quite as often, and, in our experience, more frequently, 
 met with in maniacal conditions. What is of more im- 
 portance to note is the diminished colorometric power of 
 the corpuscle, the proportion of haemoglobin varying 
 from 52 to 75 per cent. Taking into consideration the 
 corpuscular richness, we find that the absolute deficiency 
 of haemoglobin gives a corpuscular value varying from 
 56 to 89 per cent.'* 
 
 * A Text-book of Mental Diseases, by W. Bevan Lewis. Page 287, 
 1889. c 2 
 
400 ON PERNICIOUS ANAEMIA AND HYPOGLOBULIA. 
 
 Dr. Bristowe's researches on Pernicious Anaemia show 
 how, without any organic lesion that has hitherto been 
 discovered sufficient to account for it, without any 
 recognised malarious or similar influence, without any 
 apparent climatic or dietetic default, the blood under- 
 goes progressive deterioration, especially as regards the 
 number and quality of its corpuscles ; the red corpuscles 
 may be diminished by thirty or forty per cent, of their 
 proper number;* and they are also mostly smaller, paler, 
 and less consistent than usual, and tend to alter in 
 shape, and especially to become elongated and to break 
 down; and they do not usually run into rouleaux. f 
 
 * Whilst this chapter is passing through the press, my attention has been 
 called to a case of Pernicious Anaemia under the care of Dr. Lockie of 
 Carlisle, in which the red corpuscles, which had been reduced to 
 2,010,000 per cubic millimetre, under appropriate treatment, including 
 transfusion, were in a few weeks more than doubled in number, having 
 increased to 4,790000 per cubic millimetre. — British Medical Journal, 
 January 1 8th, 1890. 
 
 + Dr. Leven has made a series of observations at the Rothschild hospital, 
 demonstrating the influence of the nerve centres in increasing and diminish- 
 ing the number of blood corpuscles. Irritation of the nerve centres will 
 frequently produce aglobulia, reducing the corpuscles by several millions, 
 and it is only when this irritation is removed that their normal number is 
 restored. Dr. Leven mentions several cases illustrative of the pathogenetic 
 influence of the chemical composition of the blood, in special reference to 
 the number of the corpuscles. 
 
 Seppilli says that in the early stages of insanity, there is frequently 
 noticed a scarcity of the red blood globules as well as of haemoglobin ; also 
 that the degree of hypoglobulia and scarcity of haemoglobin vary between 
 very wide limits. The same observer gives the result of his examination of 
 the blood of 200 inmates of the asylum at Imola. The points investigated 
 were the proportion of red corpuscles (by Hayem's method), and the 
 amount of haemoglobin, as estimated by Bizzozero's chromocytometer. The 
 result showed that the red discs are less in number, and the haemoglobin 
 diminished in amount in a large number of cases of insanity in their early 
 stages — more frequently and more markedly in women than in men. This, 
 
ON THE CHEMISTRY OF THE BRAIN. 40I 
 
 Here I would observe, that although we are living in 
 an age when organic chemistry is vastly increasing our 
 knowledge of the essential nature of disease, writers on 
 disorders of the nervous system have paid but little 
 attention to the chemical pathology of the brain ; the 
 gross morphology as well as the minute structure of that 
 organ have been studied with the greatest care, and the 
 vascular arrangements by which it is supplied with blood, 
 as also the lymphatic channels by which its waste pro- 
 ducts are eliminated, are thoroughly understood, but the 
 problems involved in cerebral metamorphosis have re- 
 ceived relatively but little attention, although there are 
 good grounds for believing that changes of all kinds in 
 the nerve-centres are accompanied by certain chemical 
 phenomena. Dr. Adam Addison has paved the way for 
 more extensive researches on this subject by his ex- 
 tremely interesting and highly original paper in the 
 Journal of Mental Science for July, 1866, in which he 
 very justly says he is treading on a field which is a 
 terra incognita of unknown extent. The result of Dr. 
 Addison's observations — which are all the more valuable 
 because they are controlled by comparison with those 
 of Bibra, L'Heritier, Schlossberger and others — are as 
 follows : — 
 
 i° That the different anatomical parts of one and the same brain 
 present great differences in their quantities of water and fat. 
 
 2 That the grey substance is far poorer in fat than the white. 
 
 3 That the quantity of matters soluble in ether, stands in an in- 
 verse relation to the quantity of water. 
 
 4 That the quantities of phosphorus do not have a parallel con- 
 nection with the degree of intelligence. 
 
 he says, confirms the conclusions at which Dr. Rutherford Macphail arrived 
 in his prize essay — Rivista Sperimentale. — Italian Retrospect, Journal of 
 Mental Science, April, 1888. 
 
402 ON THE CHEMISTRY OF THE BRAIN. 
 
 5 Q That in three cases of hemiplegia the average quantity of fat 
 in the corpus striatum, optic thalamus, and grey substance of the 
 hemisphere opposite the paralysis, was less than the average 
 quantity in the same parts of the other side. 
 
 It is to be regretted that Dr. Addison did not supple- 
 ment his most useful essay by a special chemical analysis 
 of those particular portions of the brain in which the 
 seat of speech has been severally placed by the various 
 authors who have written upon the subject. 
 
 At present we are only on the very outskirts of this 
 inquiry, but before we can understand the pathological 
 chemistry of the brain, it is evident we must possess 
 accurate knowledge of the normal chemical condition of 
 that organ, a subject which has lately received consider- 
 able elucidation from the elaborate researches of Dr. 
 Thudicum, who considers the brain as the most mar- 
 vellous chemical laboratory of the animal economy ; 
 and in the chemical combinations of which the phos- 
 phorised and nitrogenised principles of the cerebral 
 tissue are susceptible, he finds the key of many of the 
 diseases of the nervous system. Chronic alcoholic in- 
 toxication he considers to be a combination of alcohol 
 with the phosphorised principles and the cerebromides, 
 such a condition being curable by dissociation, or wash- 
 ing of the alcohol out of the brain and nerves by great 
 volumes of watery blood free from alcohol, as introduced 
 by the digestive organs. 
 
 During the last few years, a fresh impetus has been 
 given to the study of the Chemistry of the Brain, and 
 it is a curious subject for inquiry how far the variation 
 in the capacity for conversational activity, depends upon 
 the chemical composition of the brain ; for there cannot 
 be a doubt that certain nations and certain individuals, 
 
PHOSPHORUS AN AGENT OF THOUGHT. 403 
 
 apparently endowed with the same intellectual power, 
 and possessing the same educational advantages, differ 
 widely in their power of expression, and in the facility 
 and brilliancy of their discourse; and it has been 
 customary to contrast, in this respect, the stolid Dutch- 
 man with the lively vivacious Frenchman. 
 
 The most extravagant notions were at one time pre- 
 valent as to the role played by phosphorus in the animal 
 economy ; the Dutch naturalist, Moleschott, maintaining 
 that " without phosphorus there was no thought ! " For 
 him, phosphorus was the great agent of thought and 
 intelligence, the universal stimulant — in fact, the soul 
 itself!* 
 
 A celebrated chemist, Couerbe, also considered phos- 
 phorus to be the exciting principle of the brain, and 
 according to him, the brain of ordinary men contained 
 2\ per cent, of phosphorus, that of the idiot i|, and that 
 of the madman 4 to 4^ ; and he stated that an average 
 proportion of phosphorus produced the admirable 
 harmony observed in the mental capacity of mankind. f 
 If it were true that a great excess of phosphorus gave 
 rise to maniacal volubility, it might be said that a 
 moderate excess of this element might explain the 
 reason why two persons with similar social and educa- 
 tional advantages should differ so widely in their power 
 
 * A Russian observer, Dr. Laleski. as the result of some experiments to 
 determine whether purpura was associated with any increase of iron in the 
 body, states that more iron appeared to exist in the grey than in the white 
 substance of the brain. 
 
 f A German. Feuerbach, adopted so firmly this phosphorus theory, that 
 he did not hesitate to attribute the cause of intellectual decay in Europe to 
 the exaggerated use of the potato, which contains very little phosphorus, 
 and he proposed to replace this vegetable by pea soup, a very phosphorised 
 aliment. 
 
404 ON THE CHEMISTRY OF THE BRAIN. 
 
 of conveying their ideas to the external world. Couerbe, 
 moreover, asserted that the brain of animals did not 
 contain phosphorus, but subsequent researches have not 
 confirmed this opinion ; and it has been proved that the 
 brain of fishes, which do not pass for great thinkers, con- 
 tains a great amount of phosphorus ; in fact, the views 
 of Couerbe on the chemistry of the brain have been 
 entirely refuted by other observers, one of whom, 
 M. Lassaigne, who analysed the brains of insane persons, 
 found that they did not contain more phosphorus than 
 the brains of healthy persons in general. 
 
 The question of the connection between the amount 
 of phosphorus in the brain and intellectual vigour has 
 attracted the attention of later observers. In 1879, 
 M. Jolly communicated to the Academy of Sciences, of 
 Paris, the result of his researches on the different modes 
 of combination of phosphoric acid in the nervous sub- 
 stances. According to this observer, the brain of the 
 calf is very rich in phosphorised elements ; in the grown 
 ox, it is the spiaal cord that contains most of them ; and 
 after alkaline phosphates, the phosphates of iron are 
 most abundant. More recently still, in 1884, M. Mairet 
 made this question the subject of a communication to 
 the same Academy, under the title of " The influence of 
 intellectual activity upon the elimination of phosphoric 
 acid in the urine." In this paper he formulated the 
 following conclusions. i° That phosphoric acid is in- 
 timately connected with the nutrition and proper work- 
 ing of the brain ; that the brain when active absorbs 
 phosphoric acid in combination with alkalis, and gives 
 out phosphoric acid in combination with alkaline earths. 
 2° That intellectual work retards general nutrition ; 
 modifies the elimination of phosphoric acid by the 
 
ON THE CHEMISTRY OF THE BRAIN. 405 
 
 urine ; diminishes the quantity of phosphoric acid 
 combined with alkalis, whilst it increases the amount of 
 the same acid in combination with alkaline earths. 
 
 To enter at large into such a comprehensive subject 
 as the Chemistry of the Brain would far exceed the limits 
 of this treatise ; it is, however, to be hoped that this 
 important subject, hitherto so much neglected, will 
 receive more attention than has hitherto been accorded 
 to it. Further researches in this direction would prove 
 extremely valuable, for the process of nutrition in different 
 tissues of the body must vary with their chemical com- 
 position, and the result may be a defective functional 
 activity which is quite compatible with an absence of 
 any apparent histological change ; and there cannot be a 
 doubt that many obscure diseases of the brain will be 
 shown to be connected with special chemical changes in 
 neoplasm, and an accurate knowledge of the chemical 
 composition of this tissue and of its constituents, must 
 materially aid us in arriving at a more correct diagnosis 
 in various forms of obscure cerebral disease. 
 
 Practitioners of the healing art are no longer divided, 
 as in the good old days of yore, into solidists and 
 humoralists, but without identifying myself with the 
 doctrine of the humoral pathologists which attributed 
 all diseases to changes in the blood, lymph, or bile, still 
 I am inclined to think that in our over anxiety to 
 connect every disorder, in some way or other, with 
 structural lesion, we are apt to overlook the condition of 
 the fluids of the body ; and in corroboration of this view, 
 I would refer to the recorded cases of loss of speech 
 from the effect of certain drugs such as Stramonium, 
 Belladonna, also from the introduction into the lymphatic 
 system of a poison from the bite of a snake. Possibly 
 
406 APHASIA, OR LOSS OF SPEECH.- 
 
 the discovery of the perivascular canals of His, and of 
 the existence of miliary aneurisms in the minute arteries, 
 of the brain, may serve as an element for a better under- 
 standing of certain functional disturbances of that organ, 
 and it is not improbable that much that is now obscure 
 in cerebral pathology may depend upon some abnormal 
 vaso-motor disturbance influencing certain parts of the 
 brain.* 
 
 In bringing this long dissertation to a close, I wish to 
 add that I am painfully sensible of the great dispropor- 
 tion which exists between the demands of this important 
 subject, and the capacity of the person who has under- 
 taken to deal with it ; and my own sense of inadequacy 
 is enhanced by the consideration, that although one of 
 the most learned scientific bodies in the world devoted 
 the long period of two months to its elucidation, the 
 discussion in the Academy of Medicine of Paris ter- 
 minated without a solution of the difficulties which its 
 members had attempted to grapple with. 
 
 I have heard it said in reference to this inquiry, cui 
 bono ? What good purpose is served by the numerous 
 and extensive researches which have been, and are still 
 being made, to decide whether we have, or have not, a 
 portion of our cerebral substance, to which belongs the 
 exclusive prerogative of presiding over articulate lan- 
 guage ? Now to this objection I would apply the trite 
 
 * In the elaborate paper by Dr. tankey, to which I have already re- 
 ferred, is the following passige corroborative of these views: — 'Each act 
 of cerebration (which results from an action of the blood and the cerebral 
 tissue) requires that the blood be unimpaired in quality, and of a just 
 quantity ; blood impaired as to quality produces imperfect cerebration, as 
 proved by the injection of poisons into the blood, ar,d by the action of 
 certain drugs which are known to enter the circulation.' 
 
ArHASIA, OR LOSS OF SPEECH. 407 
 
 remark that all knowledge is power ; besides, surely no 
 subject is more worthy of the careful investigation of all 
 labourers in the field of science than the Origin of Speech ; 
 it is one of the questions in which the physiologist and 
 the student of language meet, and now that the sluice- 
 gates of public opinion are opened upon it, error will be 
 swept away, and a fresh impulse be given to the study 
 of the mind ; and the practical discoveries and brilliant 
 achievements of recent workers in this branch of science, 
 constitute the grandest triumphs that adorn the history 
 of modern medicine. Moreover, the scientific result of 
 the recent researches about the seat of speech, need not 
 necessarily be limited to the acquisition of abetter know- 
 ledge of the conditions under which that faculty is 
 developed or lost ; for since the attention of the profession 
 has been directed to the investigation of the causes which 
 interfere with the exercise of speech, a new flood of light 
 has been thrown upon the minute anatomy and physiology 
 of the nervous centres, which may eventually lead to 
 the localisation of our other faculties, and it is not too 
 much to say that through the study of the phenomena 
 of speech, we may hope to get a clue to the solution of 
 many other problems connected with the nervous system 
 which are now shrouded in obscurity. 
 
 The definite solution of the question I have been dis- 
 cussing has been retarded by the fact that authors, in 
 many instances, have written with pre-conceived notions, 
 which really are only sketches on the canvas of their 
 fancy; upon the ground- work of problematic conceptions, 
 and arbitrary assumptions, they attempt to rear a pre- 
 mature generalisation of crude hypotheses; and their 
 works bear the impress of a desire to prove one theory 
 as against another, rather than to place on record facts 
 
408 APHASIA, OR LOSS OF SPEECH. 
 
 which may, as it were, speak for themselves. Some not 
 wishing to leave the scientific rut in which they have 
 so long moved, content themselves with boldly asserting 
 that this or that theory cannot be — that it is contrary to 
 common sense, and is the annihilation of all traditional 
 scientific data. Others decline to discuss the unilateral 
 theory, on the ground that it is impossible that a per- 
 fectly symmetrical organ like the brain should possess 
 a property in one hemisphere not appertaining to the 
 other. Now the question is not so much how it is, but 
 if it is ; we must take facts as they are, and not try to 
 make them fit in with our pre-conceived notions ; and 
 if rigorous pathological observations confirmed by necro- 
 scopic verification, should happen to furnish a number 
 of facts sufficiently significant to establish an evident 
 relation between certain functional alterations of speech, 
 and the lesion of certain definite parts of the encepha- 
 lon ; in that case, all conjectural propositions, all crude 
 assertions, and all metaphysical speculations, must vanish 
 before the light of scientific truth. 
 
 It is in the spirit of the above remarks that I have 
 endeavoured to approach this inquiry, and if in my attempt 
 to unravel the difficulties witli which this subject is 
 surrounded, I have only succeeded in making "confusion 
 worse confounded," I would say with Heberden — 
 " Fateor equidem ea esse rudia, inchoata, et manca ; cujus 
 rei culpa, tit maximum partem in me recidat, partim 
 tamen in ipsius artis conditionem erit rejicienda" 
 
I NDEX. 
 
 Abercrombie, 70, 119, 272 
 Academy of Medicine of Paris, 
 
 discussions at, 26 
 Addison, on the Chemistry of the 
 
 Brain, 400 
 Adriani, on auscultation of the 
 
 cranium, 285 
 ^lian, on gesture language, 173 
 Aglobulia, influence of the nerve 
 
 centres in, 399 
 Agraphia, not a material but a 
 
 psychical inability, 203 
 
 the morbid lesion in, 205 
 
 caused by disturbance in the 
 
 cheiro-kinaesthetic centre, 210 
 Allbutt Clifford, 281 
 Allen J., 294 
 
 Amimia, G. Ballet on, 212 
 Anaemia Perniciosa, on, 399 
 Anaesthesia psychical, on, 365 
 Anatomy Comparative, its bearing 
 
 upon the speech question, 378 
 Andral, 18 
 
 Anstie, on the sphygmograph, 283 
 Anthropology, its use to the student 
 
 of the science of language, 392 
 Ape, on the gesture language of 
 
 the, 378 
 Darwin on the emotional lan- 
 guage of the, 379 
 
 Ape, the imperfect development of 
 the third frontal convolution in 
 the, 381 
 
 Aphasics, the testamentary capacity 
 of, 301 
 
 not absovled from civil and 
 
 criminal responsibility, 312 
 
 on left-handed, 373 
 
 Aphonia not to be confounded with 
 aphasia, 278 
 
 Aphthongia, 145 
 
 Aristotle, on the sensorium com- 
 mune, 316 
 
 on the preferential use of the 
 
 right hand, 377 
 
 Asemia, 153 
 
 Asymbolia, Finkelnburg on, 151 
 
 Atmospheric changes, their effect 
 on speech, 271 
 
 Aubertin, 329 
 
 Auditory centre, on the, 40, 229 
 
 Auditory verbal memory, 180 
 
 Augier, 277 
 
 Aulus Gellius, 294 
 
 Automatic writing, Myers on, 153 
 
 utterances, 240 
 
 Autopsy mutual, the society for, 
 371 
 
 Bacon, 167 
 
4io 
 
 INDEX. 
 
 Baillarger, 223, 367 
 
 Baillie, 54 
 
 Bain, on the cerebral elements, 318 
 
 Baker Sir S., on the universality of 
 
 speech, 160 
 Ball Professor, on spasmodic ische- 
 mia, 146, 239 
 
 on traumatic aphasia, 261 
 
 his comparison of the brain to 
 
 a violin, 357 
 Ballet, 130, 218, 226, 336 
 Banks, 80, 272, 297 
 Barlow, on the location of speech 
 
 in the hippocampus minor, 386 
 Bastian, on auditory, visual, and 
 
 kinesthetic memory, 180 
 
 on sensory aphasia, 216 
 
 ; on the tardy development of 
 
 speech, 251 
 Beale, on the electrical action of 
 
 the brain cells, 397 
 Beclard, 333 
 Behier, 30 
 
 Bell ]., on traumatic aphasia, 262 
 Belladonna, its effect on speech, 
 
 273 
 Benedikt, on cerebral asymmetry 
 
 362 
 ' on the tardy development of 
 
 speech, 288 
 Bennett A. Hughes, on sensory 
 
 aphasia, 217 
 Berard, 32 
 Bergmann, 46, 244 
 Bernard Claude, 265 
 
 on mirror-writing, 210 
 
 Bernhardt, on word-deafness, 222 
 Bernheim, on hypnotism, 336 
 Bichat, on dextral pre-eminence, 
 
 374 
 Bigelow, 90 
 Billod, 302 
 
 Bishop, 161 
 
 Blanchet, on deaf-mutism, 24 
 
 Bonnet, 317 
 
 Bouchard, 362 
 
 Boudet, 243 
 
 Bouillaud, his theory of localisation, 
 
 18,325 
 
 his challenge, 27 
 
 his experiments on the brain 
 
 of animals, 384 
 Boyd, his statistics on the weight 
 
 of the brain, 366 
 Bradley, 848 
 Brain, Macewen on the surgery of 
 
 the, 253 
 from an anthropological point 
 
 of view, 367 
 not the sole organ of the mind, 
 
 325 
 
 compared to a violin, 357 
 
 minute automy of, 360 
 
 weight of its hemispheres, 366 
 
 of animals, Dr. Kichardson's 
 
 experiments on, 394 
 cells, each a minute voltaic 
 
 battery, 297 
 
 chemistry of the, 400 
 
 tumours of, their effect on 
 
 speech, 36, 253, 326 
 
 weight of, in eminent men, 367 
 
 of Gambetta, description of, 
 
 37o 
 
 Brierre de Boismont, on the speech- 
 lessness of the insane, 281 
 
 Bristowe, on the re-education of 
 the nervous centres, 298 
 
 on pernicious anaemia, 399 
 
 Broadbent, on the structure of the 
 third frontal convolution, 370 
 
 Broca, his description of the cere- 
 bral convolutions, 16 
 
 his typical cases, 20 
 
INDEX. 
 
 411 
 
 Broca, his theory of localisation, 
 
 '9, 343 
 
 on the general faculty of lan- 
 guage, 164 
 
 his mode of taking the tem- 
 perature of the cranium, 283 
 
 on cerebral symmetry, 362 
 
 on comparative craniology, 
 
 388 
 
 his comparison of the heads 
 
 of house-surgeons and those of 
 ward-attendants, 392 
 
 Browne Sir Crichton, 127, 147 
 
 W. A., 201 
 
 Brown-Sequard, 176, 270, 357 
 
 Buchwald, on minor-writing, 210 
 
 Cabanis, on the minute anatomy 
 
 of the brain, 360 
 Cadge W., 62, 327 
 Cannabis Indica, its effects on 
 
 speech, 274 
 Cartaz, on hypnotic suggestion, 338 
 Castagnon, 29 
 Catacombs of Paris, Manouvrier's 
 
 researches in the, 365 
 Catsaras, 127 
 Centre, auditory, 40, 229 
 
 visual, 40, 231 
 
 nerve, re-education of the, 
 
 297 
 Cerebral asymmetry, on, 362, 366 
 Cerise, 158 
 Charcot, his diagram of articulate 
 
 and written language, 39 
 on the passive and active 
 
 phases of language, 180 
 on hemianopsia and word- 
 blindness, 236 
 
 on hysterical mutism, 242 
 
 his experiments on hypnotism 
 
 at La Salpetriere, 334 
 
 Charpentier, on the effect of elec- 
 tricity on aphasia, 288 
 
 Chauffard, 235 
 
 Cheiro-Kinaesthetic centre, on the, 
 i8r, 210 
 
 Chemistry of the brain, on the, 400 
 
 Chloroform, its action on the brain 
 tissue, 396 
 
 Churchill, 133 
 
 Cistercian monks, their gesture-lan- 
 guage, 170 
 
 Clarke Sir Andrew, 282 
 
 Clarke Lockhart, on the olivary 
 bodies, 324 
 
 on the minute structure of the 
 
 convolutions, 368 
 
 Coleridge, 189 
 
 Common Carotid, ligature of, and 
 its effect on speech, 372 
 
 Comparative Anatomy, 378 
 
 Congenital aphasia, on, 246 
 
 Congress at Washington, discussion 
 at, 353 
 
 of psychology at Paris, 369 
 
 Convolutions, cerebral, description 
 and arrangement of, 16 
 
 minute structure of, 367 
 
 comparative development 
 
 of in animals, 380 
 
 Convolution, second frontal, its re- 
 puted reduplication in murderers, 
 362 
 
 Convolution, third frontal, its pecu- 
 liar structure, 370 
 
 — ■ its comparative de- 
 velopment in man and the ape, 382 
 
 the result of its ex- 
 
 tirpation in dogs, 385 
 its congenital ab- 
 
 sence, 348 
 
 its atrophy in a deaf- 
 
 mute, 370 
 
412 
 
 INDEX. 
 
 Convolution, third frontal, its 
 greater development in orators, 
 37o 
 
 its great size in the 
 
 brain of Gambetta, 371 
 
 Copeman, 60 
 
 Copland, 55, 286 
 
 Corneille, on the language of phy- 
 siognomy, 168 
 
 Corpus Callosum, in the ape, 382 
 
 Cortex cerebri, on the histology of 
 the, 369 
 
 Couerbe, on the phosphorus theory, 
 
 403 
 Cranial capacity, Broca on, 388 
 researches of Barnard 
 
 Davis on, 387 
 statistics of the Abbe 
 
 Frere on, 391 
 is it increasing with the 
 
 progress of civilization, 390 
 in lunatics, 362 
 
 Cranium, auscultation of the, 285 
 temperature of inside of, com- 
 pared with that of the scalp, 398 
 
 ■ regional of, 284 
 
 Crichton, 52, 190, 292 
 Criminal anthropology, 364 
 Crosse T. W., case of traumatic 
 
 aphasia, 262 
 Cruveilhier, 45, 323, 328 
 
 Dalrymple W., his case of ligature 
 
 of the left common carotid, 372 
 Dante, on natural language, 314 
 Darwin, on the emotional language 
 
 of apes, 379 
 Datura stramonium, its effect on 
 
 speech, 273 
 Davis Barnard, his craniological 
 
 researches, 387 
 Dax, 19, 330 
 
 Deaf-mutism, more common in 
 
 Jews, 246 
 Blanchet on, 248 
 
 not a bar to testamentary 
 
 capacity, 303 
 
 should not be confounded with 
 
 idiocy, 249 
 
 congress on, at Rochester, 
 
 U.S., 314 
 
 Debove, 241 
 
 Delasiauve, 122. 269 
 
 Descartes, 316 
 
 Dextral pre-eminence, on, 374 
 
 Diagnosis, 279 
 
 Dickson J. T., his experiments on 
 the frozen brain of a pigeon, 395 
 
 Discussion on aphasia, at the Aca- 
 demy of Medicine of Paris, 26, 
 
 158.333 
 
 at Dublin, 81 
 
 at Norwich, 179, 
 
 377 
 
 at Washington, 353 
 
 Duncan Matthews, 277 
 
 Duncan and Millard, on the aphasia 
 of the idiot, 249 
 
 Dunn, 64, 267, 294 
 
 Duret, on the third frontal convolu- 
 tion in dogs, 385 
 
 Duval A., on aphasia without 
 paralysis, 196 
 
 Mathias, on the brain of Gam- 
 
 betta, 370 
 
 Echo sign, 213 
 
 Egyptian mummies, the thickness 
 
 of their skulls, 391 
 Electrical action of the brain cells, 
 
 397 
 Electricity, the effects of, in defects 
 of speech, 113, 136. 288, 292 
 
INDEX. 
 
 413 
 
 Embryology — Gratiolet, Broca, and 
 
 Vogt, on, 377 
 Emotional aphasia, 203, 266 
 Epileptic logoneurosis, 136 
 Erlenmeyer, on the left-handedness 
 
 of the Hebrews, 375 
 
 on agraphia, 205 
 
 Esquirol, on the aphasia of idiocy, 
 
 249 
 on lesions observed in lunatics, 
 
 395 
 Etiology of aphasia, 245 
 Eulenberg, 147 
 
 Falret J., 301 
 
 Farrar, on sound, the vehicle of 
 
 thought, 161 
 on gesture language, 312 
 
 Fere, on cerebral asymmetry, 363 
 
 Fernet, 31 
 
 Ferrand, his experiments on the 
 action of chloroform on brain 
 tisue, 396 
 
 Ferri, on criminal anthropology, 364 
 
 Ferrier, on the visual centre, 231 
 
 on dextral pre-eminence, 374 
 
 — — on the function of the third 
 frontal convolution, 385 
 
 Feuerbach, on the phosphorus 
 theory, 403 
 
 Finkelnburg, on symbolic defects, 
 
 Flaubert, 35 [151 
 
 Flint Austin, 91 
 
 Flourens, on the cerebral convolu- 
 tions of the mammalia, 380 
 
 Flower, on metopism, 389 
 
 Font-Re'aulx, 247, 196 
 
 Foster M., 341 
 
 Foulis, 14 
 
 Fournie, on the movements of mat- 
 ter, 394 
 
 Fox Long, 347 
 
 Fraser, 74 
 
 Frere Abbe, on the gradual increase 
 
 of cranial capacity, 391 
 Frere Sir Bartle, onthe universality 
 
 of speech, 160 
 Frogs, the refrigerated brains of, 
 
 394 
 Froude, 320 
 
 Gairdner, 72^ 2 °3< 2 4°i 2 5 l 
 Galactorrhea in aphasia, on, 136 
 Gall, his system of phrenology, 317 
 Gallard, 301 
 Gambetta, description of his brain, 
 
 370 
 Gesture-language, Vossius on, 170 
 
 Tyler on, 170 
 
 Kleinpaul on, 171 
 
 Greek and Roman writers on, 
 
 172 
 
 used in making a will, 304 
 
 used for the delivery of a pre- 
 sidential address, 314 
 Ginders, on aphasia caused by the 
 
 excessive use of tobacco, 274 
 Giraudeau, on word-deafness, 220 
 Glosso-Kinaesthetic word centre, 181 
 Gogol, 9 
 Goltz, on the speech centre, 357 
 
 on the barking centre of the 
 
 dog, 385 
 
 his croaking experiment, 385 
 
 Gowers, on aphasia as a precursor 
 
 of epilepsy, 144 
 on the higher visual centre, 
 
 234 
 
 on the inhibition of the speech 
 
 centre, 257 
 
 on the fibres of the optic 
 
 tract, 343 
 
 Gradenigo, on the hearing of crimi- 
 nals, 365 
 
4^4 
 
 INDEX. 
 
 Grant Allen, on note-deafness, 223 
 
 Gratiolet, on the optic tract, 342 
 
 on the development of the 
 
 frontal convolutions, 377 
 
 his classification of the human 
 
 races, 387 
 
 on the tardy occlusion of the 
 
 anterior sutures, 392 
 
 Grasset, on the triple decussation of 
 the optic fibres, 341 
 
 seat of speech not a mathe- 
 matical point, 351 
 
 on the histology of the cerebral 
 
 cortex, 368 
 
 Graves, 79, 241 
 
 Greek Epigraphy, Roberts on, 211 
 
 Guyot, 270 
 
 Hamilton, on the cortical connec- 
 tions of the optic nerves, 342 
 
 Hammond, 94, 143, 196, 325, 356 
 
 Hartmann, on the third frontal con- 
 volution in the ape, 382 
 
 Hasbach, 49 
 
 Heads, controversy on the size of, 
 
 389 
 Broca's measurements in 
 
 different classes, 392 
 Hearing, loss of, in aphasia, 89 
 
 the psychology of, 218 
 
 of criminals, 365 
 
 Hebrews, the left-handedness of 
 
 the, 375 
 Hemianopsia, on, 236 
 H emicrania sympathetico-tonica, 
 
 H7 
 Hephaestic Hemiplegia, on, 272 
 Heredity in aphasia, 115 
 Herodotus, on the influence of head 
 
 coverings on the thickness of the 
 
 skull, 390 
 Heterophasia, 199 
 
 Heubner, 183 
 
 Hippocampus minor, its supposed 
 
 connection with speech, 386 
 Hippocrates, 15, 316 
 Hitzig, on the function of the third 
 
 frontal convolution, 385 
 Hoffmann, 271, 275, 280 
 Hofhaiier, 302 
 
 Horsley, on the motor centres, 355 
 Hovell de Berdt, on emotional 
 
 aphasia, 268 
 Huarte, on the diversity of aptitudes, 
 
 317 
 
 Huguenin, 127, 197, 256, 356 
 
 Hun, 84 
 
 Hunt, 317 
 
 Huxley, on the cerebral convolu- 
 tions, 380 
 
 Hypnotic experiments, and their 
 bearing on the localisation of 
 speech, 336 
 
 Hypnotism, its two stages, 334 
 
 Bernheim on, 336 
 
 suggestion a factor in, 338 
 
 Hysterical mutism, 241 
 
 Hysterie du sang, 364 
 
 Idiots, loss of speech in, 93 
 
 Esquirol's classification of, ac- 
 cording to the power of speech, 
 249 
 
 Kerlin's statistics of, 249 
 
 on alcoholic excesses of the 
 
 parents of, 250 
 
 Duncan and Millard, on the 
 
 training and education of, 250 
 
 congenital absence of the two 
 
 anterior lobes in, 327 
 
 Mierzejewski on the brain of, 
 
 369 
 
 amount of phosphorus in the 
 
 brain of, 403 
 
INDEX. 
 
 415 
 
 Inhibition, aphasia from, 357 
 Inhibition, speech centre, sus- 
 ceptible of, 257 
 Insane, speechlessness of the, 28 1 
 
 cranial researches in the, 362 
 
 Insanity, may be confounded with 
 
 word -deafness, 223 
 Interjectional expressions of apha- 
 
 sics, 240 
 Ireland W., 295, 366, 375 
 Iron, comparative amount in grey 
 and white substance of the brain, 
 
 403 
 Ischaemia of the brain, 146, 239 
 
 Jaccoud, 29, 322 
 
 Jackson Hughlings, 65, 197, 240 
 
 Jackson S., 83 
 
 Janet, 193 
 
 Johnson S., 188 
 
 Jolly, on the phosphorised elements 
 
 in nervous substances, 404 
 Jurisprudence of aphasia, on the, 
 
 300 
 
 Kerlin, on aphasia in the idiot, 249 
 Kinesthetic verbal memory, on, 181 
 Kleinpaul, on gesture-language, 171 
 Kussmaul, 51, 145, 174, 204, 242, 
 246, 322, 358 
 
 Labio-glosso-pharyngeal paralysis, 
 
 280 
 Lacteal derangement, 131, 277 
 Ladame, on aphasia in connection 
 
 with tumours of the brain, 36, 253 
 Ladd, on the seat of speech, 356 
 Laleski, 403 
 Lalopathia, 179 
 Langaudin, 36 
 Language, the general faculty of, 
 
 164 
 
 Language, natural and artificial, r£6 
 
 of physiognomy. [68 
 
 of gesture, 169 
 
 an acquired reflex, 175 
 
 its impressive and expressive 
 
 functions, 157 
 
 Ballet, on internal, 218 
 
 of animals, 378 
 
 of the parrot, 379 
 
 Lapeyronie, 316 
 Larrey D., 186, 257 
 
 H., 258 
 
 Lasegue, 301 
 
 Lassaigne, 404 
 
 Lawrence Sir W., the aphasia of, 
 
 212 
 Lebon, on cerebral symmetry, 362 
 Leconte, on the gesture-language of 
 
 the ape, 378 
 Left hemiplegia with aphasia, 49, 
 
 65, 124, 127 
 Legrand du Saulle, 301 
 Legrand Max, 333 
 Lelut, 333 
 Legroux, 349 
 Lemoine, 215, 378 
 Lepine, on hypnotic phenomena, 335 
 Lesur, 29 
 
 Leven, on aglobulia, 400 
 Lewis Bevan, on the histology of the 
 
 cerebral cortex, 369 
 Lingual spasm, 128 
 Lockie, on hypoglobulia, 400 
 Lohmeyer, 349 
 Lombard, 283 
 
 Lombroso, description of the habit- 
 ual homicide, 364 
 on the connection of aphasia 
 
 with cardiac disease, 264 
 LongF., 137 
 Lordat, 109 
 Louiville and Uebove, 241 
 
416 
 
 INDEX, 
 
 Lucian, on pantomimic language, 
 
 172 
 Luys, on cerebral asymmetry, 366 
 Lyons, 81 
 
 Macewen, on brain surgery, 253 
 
 Macrobius,on gesture-language, 174 
 
 Magnan, 252, 344 
 
 Mairet, on the influence of intellect- 
 ual activity on the elimination of 
 phosphoric acid, 404 
 
 Malichecq, 261 
 
 Mann, 97 
 
 Manouvrier on criminal anthro- 
 pology, 364 
 
 Manouvriez A. on loss of speech 
 after typhoid fever, 276 
 
 Maragliani, on cerebral temperature, 
 284 
 
 his thermometric experiments, 
 
 on the dead body, 398 
 
 Marcet, on treatment by electricity, 
 
 ?93< 397 
 
 Marey, 243 
 
 Marshall, on the frontal convolu- 
 tions of the microcephali, 383 
 
 Martin, on traumatic dysphasia, 258 
 
 Mattei, 291 
 
 Matter and Mind, connection be- 
 tween, 320 
 
 Maty, on the connection of loss of 
 speech with spinal disease, 59 
 
 McKelvie, 214 
 
 Maudsley, 312, 393 
 
 Mayor, an aphasic, 302 
 
 Memories, auditory, visual, and 
 kina:sthetic, 180 
 
 Metopic suture, on the, 365, 389 
 
 Meynert, his craniological re- 
 searches in lunatics, 362 
 
 Microcephali, the third frontal con- 
 Volution of the,' 381, 383 
 
 Mierzejewski, on the brain of the 
 idiot, 369 
 
 Mills C. K., on cerebral localisa- 
 tion, 353 
 
 Mills R. J., case of traumatic 
 aphasia, 262 
 
 Mirror-writing, on, 210 
 
 Moffatt, on the universality of 
 speech, 160 
 
 Moleschott, on the phosphorus 
 theory, 403 
 
 Monboddo, his "homo mutus," 160 
 
 Moore W. T., on heterophasia, 202 
 
 Moreau, on congenital absence of 
 the third frontal convolution, 348 
 
 Morgan, 213 
 
 Moxon, on brain symmetry, 361 
 
 Midler Max, on the connection be- 
 tween matter and mind, 155 
 
 on the analysis of the human 
 
 voice, 159 
 
 on speech as a specific faculty 
 
 of man, 380 
 
 Munk, 232 
 
 Murderers, the reduplication of the 
 second frontal convolution in, 362 
 
 Mutitas verminosa, 270 
 
 Myers, on automatic writing, 153 
 
 Napier L., on puerperal aphasia, 
 
 Nasse, 149 
 Neurokinesis, 26S 
 Nicolucci, on the brain from an 
 anthropological point of view, 
 
 367 
 Note-deafness, Grant Allen on, 223 
 Nothnagel, 197 
 Nunnely, 372 
 
 Oedmansson, 255, 269 
 
[NDEX. 
 
 41/ 
 
 (Knanthe crocata, causing tem- 
 porary loss of speech, 274 
 
 Ogle W., 126, 178, 206, 375 
 
 Olivary bodies, location of speech 
 in, 42 
 
 Optic fibres, decussation of, 339 
 
 course of, 342 
 
 Orators, on the brains of, 370 
 
 Osborne, 200, 228, 298 
 
 Osier, on criminal automata, 365 
 
 Utt, 276 
 
 Ovid, on the language of the phy- 
 siognomy, 168 
 
 Owen, on the hippocampus minor, 
 as a distinction between man and 
 animals, 386 
 
 Panthel, 267 
 
 Pantomimic language, 1 72 
 
 Paramimia, 212 
 
 Paraphasia, 200 
 
 Parchappe,on the physical elements 
 
 of speech, 158 
 Park, on the surgery of the brain, 
 
 353 
 Parrot, the language of the, 379 
 Pelvet, 197 
 
 Pernicious Anaemia, on, 400 
 Perroud, 212 
 Peter Michel, 32, 2S6 
 Peter the hermit, the natural lan- 
 guage of, 166 
 Pfliiger, 235 
 Phosphorus, its role in cerebral 
 
 function, 403 
 its supposed connection with 
 
 mental vigour, 404 
 Physiognomy, the language of, 168, 
 
 215 
 Physiology, 2,7 
 Physiological Psychology, Ladd on, 
 
 356 
 
 Piorry, 183, 297 
 
 Pitres, on agraphia, 207 
 
 Pliny, 185 
 
 Pons Varolii, its supposed connec- 
 tion with speech, 325 
 
 Popham, 82, 152, 178 
 
 Poupon, 134 
 
 Probate of the wills of speechless 
 testators, 302 
 
 Prognosis, 285 
 
 Proust, 39, 252 
 
 Psychical anaesthesia, on, 365 
 
 Psychology of hearing, 218 
 
 of sight, 226 
 
 of the ancients, 315 
 
 Congress of, at Paris, 369 
 
 Puerperal aphasia, 131, 277 
 
 Radcliffe, 293 
 
 Recurring utterances. 192 
 
 Reil, island of, atrophy of in deaf- 
 mutism, 247 
 
 an important char- 
 acteristic of the human brain, 
 
 33i 
 Reflex action, loss of speech from, 
 Renal inadequacy, 282 [270 
 
 Richardson, his experiments on the 
 
 frozen brain of animals, 394 
 Richter, 241 
 
 Right-handedness, its cause, 374 
 Roberts, on Greek epigraphy, 211 
 Robertson, 73 
 Roll eston, on the differences between 
 
 the brain of man and that of the 
 
 ape, 386 
 Romanes G. J., on gesture-lan- 
 guage, 313 
 
 on the seat of speech, 353 
 
 Roman writers, on the progressive 
 
 deterioration of the human family, 
 
 291 
 
4i8 
 
 INDEX. 
 
 Romberg, 45, 287 
 
 Ross, on the course of the optic 
 tracts, 342 
 
 on the impressive and expres- 
 sive mechanism of speech, 157 
 
 Rostan, 195 
 
 Rudinger, on the brain of orators, 
 37o 
 
 Ruftz, on loss of speech from the 
 bite of a serpent, 277 
 
 Rummo, 39 
 
 Rush, 188 
 
 Salpetriere, experiments at, and 
 
 their bearing on localization, 334 
 Sanders, 71 
 Sankey, 397, 406 
 Sansom, 283 
 Sauvages, 15, 270; 273 
 Schafer and Sanger Brown, on the 
 
 auditory and visual centres, 230, 
 
 232 
 Schrceder van der Kolk, 42, 27S, 
 
 321 
 Scintillant scotoma, 146 
 Seat of speech, not a mathematical 
 
 point, 351 
 Seguin, 91 
 
 Senses, suspension of all the, 64 
 .Sensory aphasia, on, 216 
 Sepelli, on word-deafness, 230 
 
 on hypoglobulia, 400 
 
 Servetus, 316 
 
 Sight, the psychology of, 226 
 
 loss of, in aphasia, 86 
 
 Shaw, on aphasia in the idiot, 250 
 
 Simon Th., 61, 259 
 
 Simpson, 67 
 
 Sireday, 133 
 
 Shakespeare, on the language of 
 
 nature, 167 
 Skae, 71 
 
 Skulls, Persians compared with 
 Egyptians, 390 
 
 ancient, Abbe Frere's collec- 
 tion of, at Paris, 391 
 
 Skwortzoff, 235 
 
 Sleep-walking and hypnotism, Tuke 
 on, 337 
 
 Smith Carmichael, 280, 291 
 
 Society for mutual autopsy, the, 371 
 
 Spectator, on heterophasia, 202 
 
 Speech, a universal attribute of 
 man, 160 
 
 — — the exclusive prerogative of 
 man, 378 
 
 a physico-psychical act, 158 
 
 the somatic, and psychical 
 
 elements of, 159 
 
 consists of a motor and a sen- 
 sory function, 157 
 
 the emissive and executive 
 
 departments of, 157 
 
 its mechanism compared to a 
 
 telegraphic apparatus, 175 
 
 an acquired reflex, 174 
 
 its seat, not a mathematical 
 
 point, 351 
 
 perversion of, 199 
 
 tardy development of, 252, 288 
 
 effect of mental shock on, 294 
 
 restoration of, by re-education 
 
 of the nervous centres, 297 
 
 comparative facility of, in 
 
 different races of mankind, 387 
 
 Spender, 334 
 
 Spenser Herbert, on localisation, 
 352 
 
 Sphygmograph, as a means of diag- 
 nosis, 282 
 
 Spiegel-Schrift, Buchwald on, 210 
 
 Spitzka, on the tendon-reflex, and 
 its relation to defects of speech, 
 271 
 
INDEX. 
 
 419 
 
 Spinal symptoms, coinciding with 
 
 aphasia, 59, 116, 119, 266 
 Spleen, fibrinous deposits in, 124, 
 
 126 
 Starr Allen, on the function of the 
 
 pons, 325 
 his address at the Washington 
 
 Congress, 353 
 Stewart, 66, 331 
 Stoker T., 297 
 Stokes Sir W., 297 
 Stramonium, its effects on speech, 
 
 273 
 Struthers, on the hat as a test of 
 
 cranial capacity, 390 
 Suggestion, a factor in hypnotic 
 
 results, 338 
 Sumpter, 115 
 
 Sunstroke with aphasia, 272 
 Symmetry of the two hemispheres, 
 
 on the, 361 
 Sympathetic system, its role in the 
 
 causation of speech disturbance, 
 
 265 
 
 Tamburini and Marchi, on cerebral 
 localisation, 253 
 
 Tendon-reflex, its supposed rela- 
 tion to defects of speech, 271 
 
 Tennyson, 167 
 
 Testamentary capacity of aphasics, 
 301 
 
 Thermal changes, their effects on 
 speech, 398 
 
 Thermometric observation in cere- 
 bral disease, 283 
 
 experiments of Maragliani on 
 
 the cadaver, 398 
 
 Thomsen's disease, 130 
 
 Thucydides, 185 
 
 Thudicum, on the chemistry of the 
 brain, 402 
 
 Tobacco, excessive use of, its effects 
 
 on speech, 274 
 Todd, 56, 267, 282, 361 
 Tongue, not essential to speech, 
 
 163 
 Traumatic aphasia, 257 
 cases of, observed by the 
 
 author, 262 
 Treatment, 290 
 Trephining in traumatic aphasia,' 
 
 260, 296 
 Tricocephalus dispar, 271 
 Trousseau, 26, 32, 144, 201 
 Tuke and Frazer, 74 
 
 Hack on hypnotism, 337 
 
 Tumours of the brain, statistics of, 
 
 36 
 Tylor, on gesture-language, 170 
 on the will of a deaf-mute, 303 
 
 Ursemic poisoning, on, 282 
 
 Urine, importance of its analysis, 
 
 99 
 in defects of speech, 281 
 
 Van Swieten, on the persistence 
 
 of aphasia after recovery from 
 
 paralysis, 287 
 Varieties of aphasia, 182 
 Vaso-motor influence on speech, 
 
 265, 406 
 Vauvenargues, 185 
 Velpeau, 27, 266 
 Verbal amnesia, 224 
 
 delirium, 204 
 
 Vigoroux, 131 
 
 Villard, 214 
 
 Violin, comparison between it and 
 
 the brain, 357 
 Visual centre, on the, 40, 231 
 verbal memory, 180 
 
420 
 
 INDEX. 
 
 Vogt C, on the development of the 
 
 frontal convolutions, 378 
 on the difference beween the 
 
 third frontal convolution in man 
 
 and in the ape, 381 
 Voice, mechanism of the, 160 
 
 of the gibbon, 378 
 
 Voisin A., on the echo sign, 213 
 on the temperature of the 
 
 cranium, 284 
 Vossius I., on gesture-language, 170 
 Vulpian, 33, 322, 330, 368 
 
 Wadham, on a left-handed family, 
 
 373 
 Waterhouse, on the voice of the 
 
 gibbon, 378 
 Watson Sir T., 55, 207, 212 
 Watson H., 131 
 Watteville de, on word-blindness 
 
 and hemianopsia, 236 
 Weight of the brains of eminent 
 
 men, 367 
 Welsford, on mirror- writing, 211 
 Wernicke, 51, 216, 223 
 
 Whispering, 243 
 
 Whitney, 156 
 
 Wibe, on verbal delirium and para- 
 phasia, 204 
 
 Wiedemeister, 295 
 
 Wigan, 295 
 
 Wilbur, on the aphasia of the idiot, 
 92, 249 
 
 Wilkinson Sir G, on the skulls of 
 the Egyptian mummies, 391 
 
 Wilks, 76, 194 
 
 Williams C, case of traumatic 
 aphasia, 260 
 
 Willis, 244, 316 
 
 Wills made by speechless testators, 
 302 
 
 Winslow, 56, 215, 286 
 
 Word-blindness, 182, 225, 310 
 
 Allen Starr's diagram of, 355 
 
 Word-deafness, 181, 219, 309 
 
 Yellowly, on aphasia from an hydatid 
 
 in the brain, 253 
 Yeo Gerald, on the visual centre, 
 
 231 
 
 JARROLD AND SONS, PRINTERS, NORWICH, YARMOUTH, AND LONDON. 
 
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