vi] Clinical Erldfitcc rcf/anllitf/ Function 165 



word-memory, as Lichtheini and others suppose; and that it is necessary for the affection 

 tn be bilateral. 



From the foregoing it is manifest that "word-deafness" in its pure and uncomplicated 

 form does not yet rest on a substantial anatomical basis; in only two cases has the clinical 

 condition been checked by a post-mortem examination, and in both of these a bilateral 

 affection of the superior temporal gyri was observed; the facts supplied do not go far in 

 enabling us to place our finger on the exact area of cortex, obliteration of which will be 

 followed by this condition in all its purity and simplicity ; and although bilaterality of lesion 

 would appear to be a sine qua nun, the fact that a similar condition, although complicated 

 by other symptoms, is known to have resulted from a one-sided lesion, shakes one's faith 

 in the double relation. 



We will now consider the variety of "word-deafness" which results from a one-sided 

 lesion ; of this form numerous instances have been recorded, and the destructive area has 

 almost invariably 1 been situated in or about the first temporal convolution of the left hemi- 

 sphere, exceptional cases being those which have occurred in left-handed individuals. But 

 although it appears that complete " word-deafness " may result from a lesion in the above- 

 mentioned region, the clinical picture is generally complicated by the presence of other 

 phenomena. From the writings of Bastian, Ferrier, von Monakow, and Miraillie, all of whom 

 have collected and analysed cases recorded in the literature and compared them with per- 

 sonally-observed instances, we find that the following additional disabilities may arise, (1) a 

 disturbance of voluntary speech, which may amount to "complete aphemia " (Bastian), or, 

 and this is much more common, it may be a degree of paraphasia ; (2) a marked inter- 

 ference with the capacity for reading aloud; (3) an inability to write spontaneously, either 

 complete or partial (agraphia or paragraphia) ; (4) occasionally an inability to copy correctly; 

 (5) a varying amount of "word-blindness"; (6) some loss of the musical faculty. 



So much for the possible complications which may attend lesions in the first temporal 

 gyms of the left side ; let us now attempt a closer investigation of the pathological anatomy 

 of these conditions. In the first place, according to Bastian, slight lesions of the gyrus 

 give rise to corresponding slight functional disability without any of the above complications, 

 a condition in which various words fail to be recalled as they are needed in ordinary 

 speech and to which he considers the term " amnesia verbalis " specially applicable ; but, 

 so far as I can ascertain, the anatomical grounds for this assumption are not so firmly estab- 

 lished as they might be, although clinical data are all in favour of such a possibility; 

 and in fact this condemnation might be extended further and applied to the pathology of 

 word-deafness generally. For notwithstanding that so many dozens of cases stand recorded in 

 the literature, it is still plain that a complete macroscopic and microscopic examination of 

 the brains of many more will have to be made before the anatomical deficiencies upon 

 which this exceedingly complex condition depends will be thoroughly and satisfactorily 

 demonstrated. Von Monakow, who is of the same opinion, might be quoted here. The 

 view which this observer favoured, after a close analysis of nearly forty cases of " word- 

 deafness " including an examination in serial sections of the brains of several cases which 

 came under his own notice was, that this clinical manifestation depended on the existence 



1 It is unfortunate that we cannot say that "word-deafness" is invariably clue to a lesion of the left superior 

 temporal gyrus. Authentic cases have been recorded in which there has been no affection of this convolution, and 

 these of course increase our difficulty in interpreting the condition. 



