APHASIA ASYMBOLIA. 285 



first symptom of the latter is always impaired articulation, which 

 gradually becomes sheer mumbling. The attitude is negligent, the 

 gait uncertain and tottering, the patient easily falls, and his hands 

 tremble when held out. Later, he cannot leave the bed, lies mo- 

 tionless, does not react to the strongest irritation, and finally dies 

 of marasmus. 



TREATMENT. We cannot expect to treat atrophy of the brain 

 successfully. Treatment must be directed against the original dis- 

 ease, to prevent the progress of the atrophy, if possible. On this 

 occasion we shall again call attention to the cold douches which 

 we recommended as peculiarly efficacious in chronic meningitis. 

 For the rest, we have to limit ourselves to combating the more 

 threatening symptoms. In monolateral agenesis, we may attempt 

 to arrest the atrophy and fatty degeneration of the muscles by 

 using the induced current of electricity, which, in this case, is of 

 course to be regarded only as a gymnastic remedy. 



[CHAPTER XVIII. 



APHASIA ASYMBOLIA. 



THEEE is a disease of the brain which, while it impairs or even 

 totally destroys the power of speech, does not in the least disable 

 the apparatus for speaking, nor derange the faculty of thinking. 

 This incapacity to express thoughts in words, although the mind be 

 clear and the muscles of speech in good order, is called aphasia. 

 Trousseau and Broca observed that such disorders of speech stood 

 in close connection with a lesion of the third frontal convolution, and 

 that nearly always an affection of the left third, and quite excep- 

 tionally a similar one of the corresponding convolution of the right 

 side, was at the root of failure of speech. This relation the French 

 authors first explained by assuming that in most persons the organ 

 of speech is developed only upon one side, and that usually the left 

 one ; while among left-handed persons the right third convolution 

 should represent the function of speech. Besides the third convo- 

 lution, however, there seem to be other spots in the brain which 

 have to do with the speaking faculty ; and in a good many cases 

 the diseased point has been found elsewhere, in the fissure of Syl- 

 vius, the island, or nearer to the corpora striata, or even in the pos- 

 terior lobes of the brain. 



The lesions which may cause aphasia are various apoplexies, 



