KM Temporal Lobe and Auditory Areas [CHAP. 



dulling of the sharpness of hearing, of sudden onset, has been attributed to lesions in one 

 temporal lobe and so given support to the anatomical supposition that each ear is connected 

 with both cortical centres; but on the other hand there are cases on record (Kaufmann 

 and Ferguson) of unilateral deafness which seem to have been dependent on lesions of 

 the first temporal gyms of the opposite side ; furthermore, there is a gradually increasing 

 number of cases in which extensive lesions of the right temporal lobe have given rise to 

 no discoverable impairment of hearing at all. In view of such conflicting evidence confusion 

 reigns on this point ; nevertheless T feel confident that a closer examination, in future cases, 

 of the extent of the destruction not only in the superior temporal convolution but in the 

 adjoining transverse temporal gyn will shed light on the question. 



The Lesions in Cases of Word-Deafness. 



We now come to a consideration of several extremely complex phenomena which attend 

 lesions of the left temporal lobe in particular, and the most important is that which we 

 understand by the name " word-deafness." In dealing with this symptom-complex it is 

 not my intention to enter into the various views upheld by the host of observers who have 

 recorded cases, my remarks will be narrowed down to an account of the facts bearing on 

 cortical localisation supplied by the autopsies in such cases. 



Simple uncomplicated word-deafness Lichtheim's " isolated speech-deafness," Wernicke's 

 " subcortical word-deafness," Dejerine's " pure word-deafness," that is, the condition in which 

 the disabilities are a failure to comprehend spoken words, and a consequent failure either 

 to repeat words, or to write from dictation, and which was supposed by Lichtheim to be 

 due to an isolation of the left auditory word-centre, by the cutting off of all its afferent 

 fibres, is evidently of rare occurrence; for Bastian, writing in 1901, states that he knows 

 of only three cases. In two of the cases referred to, those of Lichtheim and Serieux, there 

 is no account of a necropsy, but in the third, which has been well reported by Pick, the 

 autopsy revealed an old softening of the first and second temporal gyri, of the insula, and 

 of the opercular portion of the ascending and third frontal gyri on the right side, and a 

 less extensive softening of the first temporal and supramarginal gyri on the left side'. 



In addition to these, I have found a case published by Dejerine and Serieux which 

 is claimed to be the first instance of " pure word-deafness " checked and made complete by an 

 exact macroscopic and microscopic examination of the brain. For a period of five years the 

 patient exhibited the symptoms of " pure word-deafness," that is to say, integrity of the 

 power of spontaneous speech, of spontaneous writing and copying, and of reading aloud, along 

 with an inability to comprehend, repeat or write down words heard. Then the condition 

 became complicated and during the last two or three years of life, paraphasia and paragraphia, 

 finally amounting to complete loss of the power of interpreting writing, gradually appeared, 

 and also the general intelligence and sharpness of hearing suffered. At the autopsy, pro- 

 nounced bilateral atrophy of the temporal lobes, particularly of the upper gyri, was found, 

 but the insula, be it noted, was intact. 



Microscopically the changes seem to have been those of simple atrophy from localised 

 defective nutrition, or what these observers call " poliencephalitis chronica " ; and the view 

 is put forward that " pure word-deafness " is referable to cortical affection of the auditory 

 area, not to an interruption of the connections between the centres for hearing and 



