CHAP. XXIX.] SPEECH AND THOUGHT. C71 



On November 1st he was admitted into St. Thomas's Hospital, still 

 speechless, and dragging his left leg much in walking. 



Dr. Bristowe says : " Three days after admission I saw the 

 patient for the first time, and examined him pretty carefully. I 

 found that he was perfectly intelligent, that he understood every- 

 thing that was said to him, that he could read well and compre- 

 hend everything that he read, and that he could maintain a 

 conversation of any length, he writing on a slate and his inter- 

 locutor speaking. He wrote indeed with remarkable facility a very 

 excellent and legible hand, expressing himself with perfect point 

 and accuracy, except for an occasional error of spelling and con- 

 struction, due evidently to defective education. But he could not 

 speak, he could not utter a single articulate sound. I ascertained, 

 however, that he could perform with his lips, tongue, and cheeks 

 all possible forms of voluntary movement, and also that he was 

 capable of vocal intonation, in other words, that he could produce 

 musical laryngeal sounds." 



This patient was afterwards taught with great care, and with 

 complete success, to speak again, although " he had been nine 

 months entirely speechless, and believed himself to be hopelessly 

 dumb." 



The bilateral paralysis which existed at first, together 

 with complete deafness and other symptoms, make it almost 

 certain that in this case the patient was suffering from a 

 lesion situated somewhere on the confines between the 

 upper part of the Medulla and the pons Varolii. A lesion 

 here might cause the complete deafness, the double 

 paralysis, and for a time functionally disable the lower arti- 

 culatory centres. There was clearly a mere motor Speech 

 defect ; and a much slighter lesion about the same region, 

 or a little higher, might have given rise to such minor 

 symptoms as were met with in Trousseau's case. It is 

 possible, however, that this latter group of symptoms might 

 have been occasioned by a slight lesion higher up in the 

 left motor track perhaps in the Corpus Striatum, or, 

 even higher, in the white substance intervening between 

 these bodies and the Kinaesthetic Word- Centres. 



