650 THE CEREBRAL RELATIONS OF 



paid, but is affected with an incapacity to employ substantives, 

 having lost the memory of words as far as that part of speech is 

 concerned, and he will make use of a periphrasis to avoid using the 

 substantive required." A few months afterwards he became para- 

 lysed, and soon after that so demented as to necessitate his removal 

 to the Borough Asylum. 



This, in its first stage, seems to have been a case of 

 Aphasia pure and simple. Trousseau records several 

 instances in which such a condition lasted only a few days 

 or perhaps only a few hours, owing to the existence of 

 some temporary abnormal cerebral condition induced 

 occasionally without apparent cause, and at other times as 

 a sequence of some great excitement conjoined with 'worry* 

 or over- work. Such cases are not extremely rare ; two 

 or three of them have also fallen under the notice of 

 the writer. 



When however an actual lesion exists, of greater mag- 

 nitude than that which may have been present in the first 

 stage of Dr. Bateman's case, it often happens that the 

 Aphasia co-exists with a paralysis of the right side of the 

 body or a right Hemiplegia, as it is termed. 



The larger the lesion, too, the greater is the chance 

 that the Visual or the Auditory Centres themselves, or 

 some of their commissures may be seriously damaged : 

 with the effect of producing an admixture of Amnesic 

 symptoms with those of Aphasia. Such additional symp- 

 toms may reveal themselves either from the first, or only 

 as the individual begins to recover from the Aphasic 

 condition. 



Three instances of complications of this sort will now be 

 given. The first of them being a case recorded by 

 Trousseau, in which Aphasia was produced by a lesion that, 

 at the same time, caused right-sided paralysis together 

 with inability to read the latter disability being prob- 

 ably due to damage of the left Visual Word- Centre. 



