98 ^Journal of Comparative Neurology and Psychology. 



of the signs of language have been lost, and (2) in which orientation in space and 

 time, recognition (by each sense for itself), is included, i. e., sensory asymholy and 

 agnosia; or in which there is lost the ability to realize coordinated movements 

 directed to an end, i. e., motor asymholy and apraxia. Both these groups VON 

 MoNAKOW would join under the general term asemia. He showed diagrams of 

 fifty-two published cases of different forms of aphasia, with lesions in but not 

 limited to Broca's convolution, of which eight were permanent without improve- 

 ment, two were permanent with little improvement, thirteen temporary with com- 

 plete recovery, ten acute, and five with pure subcortical aphasia, while fourteen 

 cases were negative as regards speech defects. His summary of the results is that 

 aphasia, apraxia and asymboly are usually produced by lesions, more or less 

 indefinitely localized, in the left hemisphere, but that sometimes, though seldom, 

 the lesions are sharply defined. Some of these left residual conditions, while others 

 showed the phenomena only temporarily and the disorder disappeared after a 

 greater or less length of time. The latter type of cases fall into two groups: (i) in 

 which the localized symptoms disappear nearly simultaneously with the general 

 phenomena, and (2) in which the symptoms disappear after some weeks or months, 

 perhaps years, although the form of the lesion remains unaltered. The disappear- 

 ance may be gradual or all the symptoms may disappear at the same time. Some 

 remain as permanent defects. This view of the conditions in aphasia is of special 

 interest as compared with the views of Marie who, to give the situation in brief, 

 believes that all aphasic disorders are of the nature of mental defects, more or less 

 permanent, and who does not believe that the aphasias are caused by well defined 

 lesions in the cerebrum. Von Monakow believes that the sharply defined clinical 

 forms of aphasia and apraxia are due less to the injury as such, i. e., disturbance 

 of any number or quality of neurones, than to what he calls diachesis, and that the 

 better the differentiation of the symptoms the more does the principle of diachesis 

 come in. Diachesis, it should be noted, is the term used by von Monakow to 

 indicate the lack of stimulation of certain centers by impulses from other centers, 

 which normally act by their impulses as stimuli to the others. In other words, it 

 is the condition of inability of a secondary center to function because of the destruc- 

 tion or paralysis of the primary center connected with the given secondary center. 

 This is placing the blame one step further back than has usually been done. Dr. 

 Hartmann took up the subject of what problems are to be solved for a proper 

 understanding of the various speech defects. In regard to aphasia it may be taken 

 as settled that the pathological conditions of asymboly and apraxia appear when 

 both sides of the cerebrum are diseased or when one side is affected with complica- 

 tions of the fiber system of the corpus callosum. It is at present impossible to 

 refer the different forms of aphasia and apraxia to definite lesions in the brain, 

 but careful study of the residual symptoms and of those that are temporary, with 

 minute consideration of the related and general symptoms will help toward 

 a better understanding of the relation of the different parts of the cerebrum to the 

 speech functions. At present we know little regarding the normal physiology of 

 the nerve processes as compared with our anatomical knowledge and we must have 

 more information on the functional side of the associational processes before we 

 shall have an understanding of the complex associations which may be called 

 aphasia, or asemia, asymboly, apraxia, etc. 



From both the scientific and the social sides the two congresses were very 



