G72 CEREBRAL RELATIONS OF SPEECH AND THOUGHT. 



It has long been known that lesions in these situations, 

 especially in the pons Varolii, may cause great diffi- 

 culties and indistinctness of articulation, if not actual 

 loss of Speech. A briefly-related case of this kind, in 

 which a considerable lesion was actually found in this 

 situation, as recorded by Dr. Wilks, may suffice for the 

 final elucidation of this section. 



" A lady fell in a so-called fit during dinner. She was taken up 

 speechless and put to bed. She lay with her mouth open and with 

 the saliva running from it, and she was unable to swallow or to 

 speak. There appeared to be no paralysis of her limbs, and from 

 her gestures and expression there was every reason to believe that 

 she was perfectly sensible. She was soon able to leave her bed, 

 and recovered her usual health, but she never lost the paralysis of 

 the tongue and palate. She wrote down all her wants on a slate, 

 She swallowed with difficulty, and the saliva was continually flowing 

 from her mouth ; but she was able to walk three or four miles a day, 

 and was accustomed to join in a game of cards. About two years after 

 the first attack she had another apoplectic fit, in which she died. 

 On post-mortem examination there was found to be a great amount 

 of disease of the cerebral vessels ; much blood, which had escaped 

 from the pons, was effused at the base. Within the pons there was 

 an old brownish cyst. The central ganglia were healthy." 



If the foregoing interpretation of Aphemia should 

 prove to be correct, it will afford a simple explanation 

 of a class of cases which many have deemed to be as 

 puzzling as they were in the estimation of Trousseau. 

 What has been said on this subject will have sufficed 

 to show their relationship with those cases in which 

 there is unquestionably a mere difficulty in articulation 

 either complicating an ordinary attack of Hemiplegia, or 

 forming part of a degenerative disease of the Medulla, 

 known as ' Glosso-laryngeal paralysis'. On the under- 

 standing that it may be ' complete ' or ' incomplete/ 

 Aphemia is a term broad enough to include all these varie- 

 ties of mere loss of Speech or difficulty of Articulation. 



