290 ANNUAL OF SCIENTIFIC DISCOVERT. 



formation; in the third, he ceases to understand their meaning; 

 finally, all these conditions may coexist in the most complex form 

 of aphasia. 



The loss of the faculty for written language, which is so remark- 

 able a secondary phenomenon of aphasia, also exists in four de- 

 grees. In the first, the patient loses all recollection of written 

 letters or words, but is able perfectly well to copy models placed 

 before him. In the second, he is unable to write, even when under- 

 standing what he wishes to transcribe. In the third case, he has lost 

 the faculty of reading; and if he tries to write, although he suc- 

 ceeds sometimes in forming the letters well, he cannot co-ordinate 

 them into words. Finally, all understanding of written or spoken 

 language may have been completely abolished, while the rest of 

 the intellectual faculties remain completely intact. 



In the first class, there are various degrees of forgetfulness. 

 Some patients forget proper names, or the greater number of sub- 

 stantives, and express their meaning by circumlocution. Thus, 

 instead of asking for a pen, they demand something to write with. 

 Others cannot construct a complete sentence. In the second 

 class, the patients pronounce words differently from what they 

 intend, and, although conscious of their mistake, and irritated by 

 it, they are unable to rectify it. After this simple perversion of 

 language comes real impotence; the patients express all their 

 meaning with the same word, or even syllable, often utterly de- 

 void of sense. With these patients the movements of the tongue 

 are perfectly free, and there is not a trace of glosso-labio-pharyn- 

 geal paralysis. 



In the third category, the functional trouble is less grave as re- 

 gards the mechanism of speech, and more serious in respect to 

 intellectual disorder. The patients cease to understand the mean- 

 ing of their own words, and, when they wish to say one thing, 

 express a meaning directly the opposite. 



In the most complete cases of aphasia, from the testimony of 

 certain physicians who have been affected by it and recovered, the 

 intelligence is still perfectly intact. Thus, Rostan observed his 

 own case, and mentally prepared a clinical lecture upon it. What- 

 ever difliculty is encountered in intellectual exertion is not a cause 

 of the aphasia, but a result, on account of the loss of signs neces- 

 sary to give precision and support to thought. 



M. Fa'bre inclines entirely to the opinion that, in the majority 

 of cases, the left frontal lobe is the seat of the disease. Four or 

 five cases have, however, been reported, in which a destruction 

 of both the anterior lobes was unaccompanied by any symptom 

 of aphasia. In these cases, however, the posterior part of the 

 lobes was nearly intact. Moreover, M. Fabre suggests, although 

 the faculty of speech be specially localized in this part of the 

 brain, that in case of need other portions might sometimes supple- 

 ment its action. 



Again, autopsies of aphasic patients have not unfrequently re- 

 vealed lesions of various parts of the encephalon, other than the 

 frontal lol>e. But it is easily conceivable that the fibres from this 

 locality, in passing through diseased portions of brain substance, 



