3 JUNE 1871, Page 11

APHASIA.

ACURIOUS and very elaborate and careful book,* by Dr. Bateman, of Norwich, on the remarkable disease which doctors now call Aphasia, suggests a great many questions as to the nature of the working of the mind, quite as difficult and curious as any Dr. Bateman discusses in relation to the working of

the brain. Most of our readers probably know that aphasia is the general name for a disease, usually, but not, as far as is known, invariably, connected with some serious affection of the brain, which causes those who suffer from it frequently to articulate sounds or words very different from the sounds or words they are aiming at, so that an aphasic lady has been known, for instance, to come forward to meet a guest with a cordial smile and an outstretched hand, and then articulate "Pig, Brute, Stupid fool !" in place of the words of welcome really expressing the thought in her mind (Dr. Bateman, p. 105), while in other eases the words articulated when the patient was intending to read aloud, turned out simply gibberish. Thus of one patient we read :—

" In order to ascertain and place on record the peculiar imperfection of language which he exhibited, Dr. Osborne selected the following sen- tence 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 trothotod,00 to =forum or that emidrate em n einkrastrai niestreit to ketra totombreidei to ra fromtreido asthat kekritest,' "

—where, as the physician remarked, the patient, though unable to articulate the words and letters before him, did yet articulate combinations of letters and words much more difficult. Again,

there is a case registered where a man with this affection lost his way, as one may say, only in relation to a single letter,— always substituting z for f, so that asking (in German) for Kaffee, (coffee), he appeared to ask for Kazzee (sounded like Katze, cat,) (Dr. Bateman, p. 53). Again, another case is given (p. 100) of a gentleman who after a blow on the head lost his knowledge of Greek, and did not appear to have lost anything else. Evidently, then, this affection of the mind, to whatever cause due, is to be

found in the most curiously different modes and degrees,—in one case seeming to consist in mere loss of power over the muscles of articulation so that the patient articulates completely different sounds from those he intends to articulate, yet is aware of his own failure to say what he means,—in another he retains this power in full, except in the caseof a single letter for which he always substitutes one and the same letter, though a wrong one,—while in another case, a whole province of assimilated sounds vanishes from his memory in a single group, and is obliterated just as it would be by complete disuse. In some cases, then, the mind seems to go in search of the right sound or word, and to seize hold of the wrong one, through some confusion in the action of the proper nerves or

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muscles ; in some cases not to know even at which sounds to aim at all. Now, what is the proper mental interpretation of such facts as these? 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 ?

As regards the mere incapacity for rightly directing the muscles so as to articulate the proper sounds, while the clear power to recognize the right sounds, as articulated by others, remains,— the commonest sort of apbasia,—we do not know that there is anything more remarkable than in that incapacity 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 streets, suddenly points up to the clock of St. Paul's instead of shaking hands, is really in pre- cisely the same position as the lady who said "rig, brute, stupid fool," instead of "I am very glad to see you,"—supposing, that is, that the latter clearly recognized her own misdirection 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 move- ments of the arm, there is no real difference. A man partially paralyzed 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 his mind over his body. And so also it is, when the wrong words come out of the mouth, and are recognized by the speaker to be the wrong words. And even when they are not so recognized,—even when a certain amount of failure of memory is added to the failure of muscular power, there is at least no greater problem than in the case of any other failure of memory caused by physical disease. All you have in that case is what is so commonly seen in paralysis, a simultaneous failure of regulating power and of physical energy. Sometimes the physical energy will go without the regulating power ; sometimes the regulating power without the physical energy ; and sometimes they will go together. But there is at least no greater difficulty about this class of cases of aphasia than about the ordinary cases of paralysis,—the peculiarity being simply this, that so much useless articulating power is left, which we hardly expect to see left when that which makes it useful, the power to economize and direct it aright, is taken away. There is, however, nothing more surprising in the survival of the power to articulate without the power to discriminate the exact sounds which you desire to articulate, than in the survival of the power to think without the power to direct the current of your own thoughts,—than which nothing is more common. The forme* loss is the loss of the link between volition and articulation,—the latter the loss of the link between volition and thought. Perhaps the latter is the more rather than the less surprising loss of the two ; yet how completely it may be sometimes seen in opium-eaters, has long been one of the most familiar of the facts of morbid psychology.

But there is a class of cases to which we have slightly alluded that does seem to involve a much greater paradox than this. The case of the patient who, by a blow on his head, lost completely the knowledge of Greek, without appearing to suffer any other loss whatever, would to many suggest, as the physician who attended him (Dr. Scoresby Jackson) remarked, that the Greek knowledge was all " deposited" in a particular square inch of brain, the injury of which just destroyed this knowledge without invading any other sphere of the intellect. Fortunately, however, this kind of fact does not stand alone. A French priest, attended by h1. Piorry, after an attack of paralysis lost entirely the power of employing substantives, while retaining in general the full com- mand of all other parts of speech. Thus, when he wanted to ask for his hat, he said, " Donnez-moi ce qui se met sur la. . . ." but he could not remember the word for 'head' any better than the word for ' hat ;' and his physician adds, " mais le mot Cele ' ne lui venait pas," and goes on to say that he sought to express the same thing twenty times, but that he always got to an insur- mountable difficulty whenever he came to a noun substantive. Again, a Dublin physician, Dr. Graves, had a case in which a patient could not recall any noun substantive (common or proper), but could always recall its initial letter. He, therefore, made himself a pocket dictionary of the words in the most general use, including the proper names of his chil- dren and servants and friends, and in conversation would always refer to this dictionary, and run his eye down the initial letter he recalled till he reached the name of which he was in search," keep- ing his finger and eye fixed on the word until he had finished his sentence ;"—but the moment he had closed the book he again for- got the name, though he never forgot the initial letter, and could

always again recover it by means of his dictionary. Now, take these three cases together, and we observe that in one case the whole network of associations contained in a single language was lost through the agency of the disease ; in the next case, only all the examples of a single part of speech (noun substantives) in one language ; in the last case not even this, but all the examples of the same part of speech, minus the initial letter, which was uniformly retained. These last cases show pretty conclusively, —what, indeed, every sensible man would judge at once,—that it was not owing to the connection of Greek with any particular spot on the brain that the Greek, and the Greek alone, fled the first-named patient's memory after the blow. For in the second case the link between the memory's failures was that which binds together the same part of speech, all specimens of which were blotted out from a memory otherwise retaining command of the language ; and in the third case, it did not even go so far as that, but only blotted out all that followed the first letter in the names belonging to that part of speech, leaving the initial of the noun substantive as completely at command as it did all the letters of the other parts of speech. Now if it be extravagantly absurd to suppose that a distinct spot in the brain would need to be injured not only for every part of speech in every separate tongue, but for every separate letter in those parts of speech, and that it would take a rather greater injury to the brain to blot out, for instance, a word of six letters than one of five,—the supposi- tion that the knowledge of Greek, and of Greek alone was lost as a result of the particular spot of the brain on which the blow de- scended, must be quite as absurd ; for the same kind of inference would be just as legitimate to show that the names of the noun substantives of each language had a spot in the brain to themselves, and each letter of each noun substantive also.

What, then, do these curious cases point to? We suspect to this,—that injuries to the brain, and especially to the nervous ,system, are very apt to deprive us, first of our command of those acquisitions of knowledge which have owed most to laborious efforts of attention, and least to mere routine or unconscious habit. Every one must have noticed how when he begins to think closely of the composition of some word which he may have written a hundred times every day of his life, the word seems to grow unreal and unmeaning to him, till he cannot for his life know how to spell it, or whether it be a real word at all. To regain its naturalness, he must come on it by a side-path,—must surprise it, as it were, without having the gaze of his mind fixed full upon it. Well, our theory is that anything which tends to break the link,— as all paralytic affections clearly do,—between the will and the trains of thought, affects first those conceptions which have been -most studiously and laboriously and self-consciously acquired. There is a case of a patient in the Edinburgh Royal Infirmary, under Dr. Gairdner, whose loss of language was so complete, that he could communicate with other people only by signs (Dr. Bateman, p. 112). After a time, Dr. Gairdner observed that the other patients in the Infirmary thought this man was shamming, and the reason they gave was, that though he could not speak in any other way, he could swear freely. Yet this patient soon after died suddenly, and his brain was found to be much eaten away by cancer. And the explanation offered by Dr. Hughlings Jackson of such a capacity to swear found in patients who had lost their ordinary power of communicating their thoughts, is very remarkable. The will, he says, has lost the power to command the articulation, but the involuntary emotions have not ; and ejaculations of all kinds are probably due to the action of the involuntary part of the nervous system, to what is called "reflex action." "Just as a paralyzed foot will jump up when the sole is tickled, so these words" (ejaculations, oaths, &c.) "start out when the mind is excited. Such ejaculations seem to have become easy by long habit, and require but slight stimulus for perfect execution." If that explanation has, as we believe, a great deal of truth in it, it might account for the disappearance of a laboriously ac- quired language, before any impression had been made on any other language more completely bound up with the familiar life of ordinary habit. And it would also perhaps account for the two or three cases in which noun substantives disappear, or at least seem to disappear, before other parts of speech. With regard to proper names, it is matter of notoriety how much more easily they slip the memory than any others, and we suspect the reason is simply this,—that these names, only denoting individuals and not qualities, do not get embedded in phrases in which they are always recurring involuntarily, and without any effort of attention, but always require some effort of deliberate and conscious recollection, however slight, to recover them. And in a much less degree, the same is true of common nouns, at

least in the cases in which the memory appears to fail with rela- tion to them, namely, as the predicates of sentences. We suspect that aphasic patients, if their cases were properly examined, would be found to forget adjectives and verbs used predicatively, i.e., in the focal points of sentences, quite as much. But when a certain partial deprivation of speech has taken place, nouns are so much more useful than any other parts of speech that the effort of the patient's attention is sure to be fixed on the noun. If the poor old priest had had two hats and had wished to describe which of the two he wanted, we suspect the failure would have come in rela- tion to the descriptive adjective rather than the noun. If he had wished to say, "Give me the white one," the embarrassment would have arisen at the word ' white.' So, had he wished to say, "I don't wish to walk, but to ride," it seems to us most probable that his memory would have failed him at the verb, where the focus of the attention in this case is situated. Similarly we should account for the case of the farmer who could index all the wanting nouns by their first letters. We should think it likely that the look of the words had associated itself in his mind with their first letters without any sort of effort of attention,—by one of those incidental acquisitions of memory which take so much more hold upon us because they are never consciously learnt,—and that therefore these first letters had survived in his memory the full names and sounds to which, before he had learned them, he had probably had to give a certain amount of voluntary and conscious effort. Every one knows that when in search of a word, the first thing his memory catches hold of is the look or sound of some predominant letter in it, which has incidentally forced itself on his attention, whether by the eye or the voice. Some people never recognize words so easily by sound as by sight ; and these are usually readers who have come across the word involuntarily, in a book, fifty times for every time they have pronounced it with their own lips.

We suspect, then, that in cases of aphasia, it is not the part of the brain affected which determines the particular loss of naming power, but the history of the individual intellect, and that that side of the memory is soonest affected which has owed most to laborious and conscious effort. One thing the history of aphasia certainly proves,—that thought, and clear thought, is possible without names, a proposition very often indeed denied.