APHASIA.
DICKENS relates of some lady in Dombey and Son, if we remem- ber rightly, that she used to recall the great Mohammedan formula in the very lucid form, "There's no what's his name but Thingumy, and what you may call him is his prophet," and that she was perfectly successful in conveying by this rather rough verbal machinery her meaning to her friends. Well, the tendency which more or less exists, we suppose, in most declining and overfagged memories to make out their accounts in blank, as it were, and trust to the power of association in the minds of others to fill up the blanks correctly, is sometimes carried to an extent and comes on with a suddenness that have obliged physicians to give it a special name of its own ; and it is now called by Dr. Gairdner, in a very able paper read before the Philosophical Society of Glasgow, Aphasia, and regarded as a disease which, though originating in the nerves, does not necessarily or usually involve the slightest difficulty in articulating, being usually accompanied by the most complete power over the organs of speech, though by an utter incapacity to choose words appropriate to the thought in the mind of the speaker. In its most striking form, aphasia is a sudden and complete loss of recognition for words and their meaning, while in milder forms the patient can still describe by a periphrasis the object which he wishes to mention, but has to wander round it and indicate it by stray shots, as it were, instead of naming it outright. One case of this kind of a very remarkable nature once came under the present writer's notice. The patient in this case often indicated very graphically what he really meant, though he could not name it. He spoke, for instance, of the moon as "that public light ;" of Heaven,—in a metaphor taken from the habits of a lodger,—as "the front apartment ;" of the Deity himself as "that principal member ;" of acquaintances and friends,—in metaphors taken from the Classificatory sciences,—as new or old "specimens." Some- times he would miss his way further, and substitute an entirely wrong word, as " cigars " for "cards," but usually words which he unconsciously selected to express his meaning had a curiously close and even humorous relation to that meaning, though he was himself quite unaware that there was anything eccentric in his terminology. Dr. Gairdner illustrates by many curious cases the same incapacity in all degrees, ranging from that of patients to whom every word in their own language had suddenly become as those of an unknown language, to that of patients who had simply great additional difficulty in selecting their language, and a disposition to distribute names in- correctly amongst the persons and objects to whom therbelonged, —without, however, in any way confusing those persons and objects in themselves, though sorely puzzled as to their labels. The disease of aphasia indeed reminds us closely of Plato's humorous illustration of the nature of false notions in the Themtetus, where he likens a man who gets hold of wrong conceptions about things to a man with a large dovecote containing different kinds of doves, wild and tame, and who, when he means to catch a wood pigeon, may happen to set all the wood pigeons flying away from him, and to lay his hand upon a cropper pigeon instead. The only difference is that Plato means to illustrate the getting hold of a falsehood instead of a truth ; while aphasia means rather the getting hold of a false word or of no word at all instead of the right word,—the object itself being clear to the mind all the while. Thus Dr. Gairdner tried to tell an aphasic patient that his brother John had been ill. The words "brother John" carried no meaning at all, but the slightest sign or objective indication of the person named carried at once the fullest meaning to his mind. There are two very curious and characteristic facts connected with this aphasia ; the one is that the words which seem to come most rapidly and easily to the lips of an aphasic patient are words rather exclamatory and interjectional than words of proper meaning. Words of impatience, or of anger, for instance, seem to flow easily from lips which cannot express any connected sentence at all ; and so also words of surprise and pleasure,—and this not because they are recollected words, but because they need no recollection, being properly signs of emotion, and nearer in their character to tears, smiles, and gestures than to words of coherent meaning. Dr. Gairdner quotes another medical authority on the subject of the power of swearing which these aphasic patients retain. Dr. Jackson explains it by saying that "swearing is, strictly speaking, not a part of language. It belongs to the same general category as loudness of tone and violence of gesticulation." And the same may be said of course of all habitual forms of eager ejaculation, whether angry or pleased. These expressions are not consciously reproduced ; they are thrown off unconsciously, almost involuntarily, like frowns and smiles. On the other hand, the words which vanish first, and most successfully evade recapture are proper names, which are the most arbitrary, the least likely to"rise to the lips," the most like voluntarily affixed labels, of all sorts of words. The contrast is seen clearly enough by compar- ing the intellectual approaches to the boyish exclamation (say) "Gemini gosh!" or " Criky !" with those to the same expressions if used as a proper name or as a slang adjective. In the former case there is as little consideration or thought interposed between the surprise which elicits the exclamation and the exclamation, as there is in a dog's mind between a noise at the gate and its own bark. In the latter case—cases of proper names—you must get at the name through the idea of the persons to whom it belongs. Any man who notices his own thoughts about his friends will observe that he seldom thinks of them by name, unless he also wishes to speak- to them or of them. That is a distinct and superadded mental act, which obliges him to go on further than the idea and name the name if he can. This is especially true of proper names, and to some extent true even of common names. You often think of a horse, or a wood, or a mountain, if you have no occasion to express your thoughts, in a sort of vague picture, and without names occurring to the mind at all. But still more do you think of individual friends without their proper names, which really add nothing, though common names often do, to the contents of your thoughts ; and hence, we take it, the additional effort which it so often requires to run down, as it were, a proper name, beyond what it takes to catch even the exact common name of which pop may be in search. We take it that the special characteristic of aphasia is the exaggera- tion of that same species of nervousness which so often causes men to blunder especially where they are specially anxious to recollect. Every one knows that if you have lost a line of poetry, and can come at it with a run, without fixing your atten- tion on the thought and the context, you have infinitely more chance of recovering it than if you fix your mind on it from a distance and advance with conscious deliberation, getting more helpless as you approach the dangerous place. lt is almost like the physical difficulty of a leap:which one cannot take standing, but which one can make it almost impossible for oneself not to take by coming with great velocity to the spot. Even then, if one thinks too much of the chance of failure, one will start aside at the very last moment,---not owing to the deficiency of physical power, but to the paralyzing effects of too much consciousness. That is, we take it, a small ease of what the physicians call aphasia in regard to speech. They tell us that aphasic patients 'when recovering can begin all sorts of sentences, but pull short up as they approaoh either the predicate, or any word which requires, as it were, a little side excursion of con- scious effort in search of it. In short they fail at the parts of the , sentence where there is most need for attention and voli- lion,—not because they lose the ideas, since they have the idea even vividly before them, but because they have lost confidence in their own power to pronounce the talisman which will recall it to other minds,—just as the man in The -Forty Thieves could not recall "Open sesame" precisely because it was the word on Which his fate and fortune entirely depended. The predicates— and in a degree the proper names—are in a certain sense the moral crises of the sentence, the points on which communication with the outer world depends. One of the patients, for in- stance, began sentences habitually, and got as far as "I don't be- lieve," "I don't care," and in one case "Mr. Thingumbob," butwhen he got to the critical point, of what he didn't believe, or didn't care, or what Mr. Thingumbob did, or what his exact name was, he broke down ; and yet the evidence was explicit that he knew what he meant to say, as he could eke out his imperfect sentences -very completely by signs. The point where nervousness centres is precisely the point at which a junction with the outer world is going to be effected by language. In the ease of the patient we have before spoken of,—it was very remarkable that he constantly referred to "his communications being cut off" in a most pathetic manner,—and this much -more from his inability to understand the meaning of the word used by another, than from his inability to select the right word himself. His mind was like a telegraphic apparatus to which he had half lost the key. Sometimes, if he were not trying to attend, he would take the meaning of a -word used in his presence completely. At others, if he were, he would miss the meaning of the commonest word, as if it were a telegraphic symbol to which the key was lost. And yet his objective thoughts, so far as they were clear at till, were usually accurate enough, though the machinery for expressing them was so much out of order. Dr. Gairdner mentions the case of an eininent professor of medicine, M. Lordat, who had an attack of this kind and com- pletely recovered from it, and who subsequently gave his own account of the attack, from which it would not appear that he lost any power of, thought at all :— " It appears that M. Lordat in the aphasic state was able to think, to arrange the materials of a lecture, and to change the distribution of them ; while neither by speech nor by writing was it possible for him to communicate an idea; and this although there was no paralysis. I reflected,' he writes, '-on the Christian doxology, Glory be to the Father, and to the Son, and to the Holy Ghost,' and it was impossible for me to recall-even a single word of it.' The thought remained intact, but the -power of expression was gone. At the same time he convinced himself that he could combine abstract ideas, and distinguish them quite well from each other, without having a single ward to express them, and without in the least degree thinking on the expression of them. I experienced,' he adds, 'no embarrassment in the exercise of thought. Accustomed as I was for so many years to perform the work of a teacher, I congratulated myself on being able to arrange in my head the principal propositions of a lecture, and on finding no difficulty in changing the order of ideas as I pleased.'" Almost every one must have experienced something like the kind of paralysis of expressive power which is the peculiarity of attacks of aphasia, in the mere effort to fix the mind very closely on any root word, and ask why it should have got the meaning which it has. Gradually, and the more one thinks of the word, the more silly and unmeaning it appears, till at last ono really doubts whether there is such a word at all, or if there is, what it means. This state of mind is particularly easy to reproduce in the case of a primitive word which does not lead you on by any etymological associa- tion to others from which it is derived. The mere variety of thought caused by derivation relaxes the strain on the attention, and gives a sort of regular place in society to the word,---which is absent if the word happens to be or to seem to you at the moment an isolated primitive word. Take the word glad,' for instance (which is, we believe, Anglo-Saxon). Put it at the focus of the lens of thought for a few seconds, and it will turn opaque, and begin to lose itsianearting, and sound a foolish sort of word, not calculated- to exprestimeaning at all, —soon scarcely a word at all,—an illusion, an impostor, a sound which tries to make us believe that it will mean something to other-people, but which will betray us ands stultify.us if we trust to it. We take it that aphasia is a sort of-nervous paralysis attending the act of communi- cating thought, to which people are specially liable who think much without words in dumb inarticulate images to themselves, and who get nervous from the demand on their attention in the act of con- scious telegraphing to others. Of course, like all other sorts of para- lysis, physical causes probably lead to it. But the reason paralysis touches one man in the form of aphasia, and another in the form of a shaking hand or drawn mouth, may very likely be that the first has always had to put more strain on those nerves which ar,::./ put in action when he. interprets himself, translates himself to another,--while the last has had to put more strain upon, the nerves which govern his physical movements. We hear as we write that a popular French poet, M. Charles Baudelaire, is suf- fering from an attack of aphasia, and that he has always been considered one of those poets who are rather artists, in words. We should fully expect that poets of that class, whose-words are chosen deliberately rather than instinctively, and the, general strain on whose nervous power in selecting language must be very great, would be marked outIts the most likely patients for such a disease.
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