LORD DENMAN'S APHASIA.
THE interesting memoir just published of the late Lord Denman contains an account of the very curious variety of Aphasia from which he suffered for nearly two years, between his third stroke of paralysis and his death. Lord Denman's intellect remained perfectly clear to the last. He understood all that was read or said to him, whether in French or English, and majoyed even poetry as much as ever ; but he was utterly unable not only to articulate at all, but to form written words at will, unless with a copy before him of what he had to write. Thus he could not Oen sign his name to a deed without copying the signature from the writing of somebody else, though his head was perfectly clear as to the meaning of the act and the necessity of the signa- ture. Perhaps the most curious illustration of the paradox is this, —that while he knew all the letters perfectly and could dis- tinguish any ivory letter named to him in an ivory alphabet, "to form these letters into words, or words into sentences, was utterly beyond his power, unless the words and sentences were written or put together as a model, for him to copy from." The way he acknowledged the letters he received was "to copy, in a formal print hand," any passage in them which gave him particular pleasure, and to send it back to the writer. He could not originate even the shortest sentence, though his interest in Shakespeare and Racine was as keen as ever. His ear for pronunciation and his sense of the ludicrous in false pronunciation was quite unaffected ; thus he was found one day laughing heartily at the mistake of a child who, reading to him the life of Theodore Hook, read the word " hoax " as if it were a two-syllabled word, ho-ax, and he could only explain his laughter to a third person by pointing the child's attention to the word, when she immediately repeated her blunder, to Lord Denman's great amusement. Thus it is quite clear that the power of words, whether written or pronounced, to awaken clear ideas and images in Lord Denman was entirely un- touched, while the power of clear thoughts or images to sug- gest either the sequence of sounds comprised in names, or the sequence of acts comprised in writing, was probably wholly gone. We say ' probably ' wholly gone, because there is nothing to prove for certain that he may not have had the vocal impression in his ears of the names which he wished to articulate without being able to articulate them ; but that is hardly likely, since we know that he had completely the physical power to write any letters placed before his eyes, and that the point where his power failed was not in the physical writing of the letters, but in the failure of his thought to suggest to him either the words or the letters that he wanted. It seems, therefore, much the most probable that even as to speaking, the reason for the dumbness was not solely the refusal of the proper nerves to move the muscles rightly, but quite as much the failure- of the thought or image itself to set any train of language- associations in motion, whether those by which name-sounds, or those by which written words result. Here we have, then, the curious fact that language,—whether written or spoken,— awakened thought as well as ever, but that thought had lost all its initiative in suggesting either the motions of the mouth or the motions of the hand by which ie had been accustomed to find expression. And yet the power of thought to originate other and ruder forms of expression had not by any means ceased. He was fond of hearing law reports. read
aloud to him, and "he showed," we are told, "by his countenance and by signs that he not only appreciated fine passages, but that
he perfectly understood controverted points [of law], and could he have expressed himself, was as capable as ever of deciding them." Hence it was not that thought and feeling had lost all initiative power in him. They still suggested the natural signs by which he expressed interest and intelligence, but they no longer suggested to him either the sounds or the motions by the artificial aid of which alone the finer shades of meaning could be expressed. Will anyone maintain that in such a case language was essential to thought, as has been maintained so often ? If so, such a person must supply a new definition of language. It can hardly be that a word of which you cannot recall either the sound or the look,— though you recognise its meaning the moment it is presented to you,—is essential to the thought which seeks for its proper ex-. preasion and fails to find it. It may, perhaps, be maintained that the memory that there is such a word remains, though the word itself is inaccessible, just as in health we sometimes catch ourselves hunting for a word more suitable to our thought, confident that such a word exists, and yet unable to recover either the associations of sound or the associations of sight which would restore it. That is an experience common enough, and we should have supposed quite sufficient to disprove the notion that language and thought are inseparable. But a case like Lord Denman's is far stronger. For his mind did not even seem to be on the track of the missing sound or printed characters. In fact, the mind of Lord Denman was, at this time, in relation to all language, just in the same atti- tude in which ordinary minds stand towards the peculiar style and hand-writing of a friend, with whose accent and modes of speech and manner of penmanship we are perfectly familiar, but which we never try to reproduce, and could not, even if we wished it, reproduce for ourselves. He understood when presented to him, English and French sounds, and English and -French written or printed characters, as well as ever,—but both the sounds and the written and printed characters remained outside the circle of his thoughts, and were not even suggested to him by those thoughts. If thought were a process absolutely dependent on language, as has been maintained, it would be impossible to explain what Lord Den- man's mind was doing at the time when he intimated that he had a clear legal opinion on the points of law raised, without his having any possible means of either pronouncing, or writing, or apparently even thinking the words in which that opinion might be commu- nicated to those around him. It would hardly be possible to maintain that a man could think clearly in words of which he could not retain the memory for a moment after they had been uttered in his hearing. And if you can admit that it is possible to think clearly in the ghosts of words, words completely forgotten by the thinker, it is surely not more difficult, but much less difficult to, admit, that you can think clearly without words at all.
When we compare Lord Denman's kind of aphasia with the best known previous instances of the same order of complaint, we can hardly help conjecturing that even in cases of paralysis where the patient can neither understand what is said or read to him, nor convey to others any trace of his own thoughts, there may be a very real intellectual life going on within him, though one quite inaccessible to us. The forms of aphasia hitherto most usual have been,—first, partial incapacity to find the right words or sounds for the patient's thought,—an incapacity of all shades and degrees,—or, next, complete incapacity to hit upon a par- ticular class of words, accompanied sometimes by an equally complete incapacity to understand words of that class when uttered. Thus one aphasic patient could speak quite correctly but for his nouns, none of which could he recall at all ; another could recall the first letter of all the nouns he needed, but not the remaining letters, and had to help himself by a little dictionary of the nouns he needed most, arranged in alphabetical order ; while yet another only showed the affection from which he was suffering by a uniform substitution of the letter z for the letter f wherever it occurred. Again, one such patient forgot the whole of his Greek, and nothing else, after the blow which struck him down. And very many, while able to articulate quite freely, use all sorts of wrong words in the place of the right ones, sometimes substi- tuting very ingenious and picturesque equivalents, and some- times words of wholly different significance. But the common mark of aphasia in all alike is, that the command of the mind over language is very much more affected than the clear- ness of the mind itself. In some cases the whole of some linguistic acquirement seems to be suddenly cancelled, as in that of the man who forgot all his Greek, but nothing else. In much more numerous cases, language conveys the same meaning as before to the mind, but the mind loses more or less of its control over language. In Lord De,nman's case this last phenomenon was complete and well marked, without the least sign of the converse effect. But where we have so great a number of degrees of the same phenomenon, —the phenomenon of coherent thought with grave injuries of the most strangely limited character to the communicating or apprehending or both communicating and apprehending faculty,—is it not reason- able to conjecture that even in cases where no trace of the power of either apprehending or communicating remains, there may still be, —as in the instance of the patient who recently recorded his own impressions of etherisation in these columns,—a keen intel- lectual life behind the wreck of the nervous system, though one completely cut off from the external world ? We must remember that though Lord Denman was able to show his intelligent appreciation of all that was said and read to him, and wholly unable to convey his own thoughts in return, there is probably no intrinsic reason why the opposite condition of mind, —though the present writer knows of no recorded case,—should not exist, namely, a complete inability to understand and apprehend the language of others, with perfect capacity to convey your own. It is, indeed, quite possible that some of the cases of apparent in- sanity might be thus explained. Of course, a man who under- stood nothing said to him, but was yet able to speak his own mind freely, would seem much less sane than one who under- stood completely what others said, but could convey no drift of his own. Yet there is nothing essentially different in the kind of the two incapacities, beyond this, that the failure of the patient to apprehend the meaning of the rest of the world shocks that world much more gravely than the mere failure of the patient to convey his own meaning. But if the break-down of the efferent nerves (which convey messages from the mind to the outer world) is consistent with a real intellectual life within, so, it would seem, might be the break-down of the afferent nerves (which convey messages from the external world to the individual mind) ; and if so, why might not the break-down of both classes of nervous energies, at once, be still consistent with a real centre of incom- municable, but not the less true intellectual life ? We have heard that such a patient afterwards described the state in which he could neither understand the meaning of others, nor convey his own, as "a state of windowless misery,"—a very expressive term, which we may fairly suspect describes truly the condition of not a few lingering paralytics who are erroneously supposed to have lost their minds altogether with the loss of their power both of receiving com- munications from the outer world and of transmitting communi- cations to it. Certainly the very striking description of Lord Denman's state suggests to us that this may be far con3moner than is supposed. If, before his death, he had lost the power of un- derstanding spoken and written language, as he had previously lost the power of speaking and writing it out of his own mind, of course the signs of intelligence to those around him would have vanished at once. • But it seems to us quite clear that it would not in the least have followed that the intellectual life, which was evidently so keen after his first loss, might not have survived the second. Of course his mind must then have dealt with feelings, thoughts, and memories neither suggested by his attendants nor shared with them,—auch feelings, thoughts, and memories as those of which our correspondent of three weeks ago, when under the influence of ether, found himself still master. But these would not have been the less real for being altogether unehared with those around him. And it seems to us a very high probability that such states of active intellect those are, even when, to all around the patient, there appears to be no external sign of anything but imbecility and complete obtuseness to the sphere of outward things.
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