286 DISEASES OF THE BRAIN. 



inflammatory and embolic points of softening, injuries of the head 

 followed by inflammatory growths, and the like. When the lesion 

 is extensive, of course other functional derangements of the brain 

 will accompany the aphasia. These coarse structural changes, how- 

 ever, are not the only causes of aphasia. It has appeared during 

 the course of acute infectious disease, such as typhus, and as a con- 

 sequence of poisoning by lead, belladonna, and chloroform. It has 

 also arisen in hysteria and epilepsy, as well as after violent mental 

 emotion. 



Generally only one or two words remain at the command of an 

 aphasic person. With these he in vain strives to express his 

 thoughts, repeating them malapropos on all occasions. In some 

 cases the speech is quite lost, or the patient can only utter unintel- 

 ligible sounds. Although this lack of power to clothe the thoughts 

 in words is the commonest and most marked phenomenon, yet it is 

 not the only one. Very often the patient cannot write (agraphid) 

 nor read (alexia) ; sometimes even the power to communicate ideas 

 by gesture is also lost. Hence the term asymbolia (Finkelburg) 

 would seem more suitable to the disease than aphasia. Finkelburg 

 defines asymbolia as an affection in which the faculty of conveying 

 .ideas by means of signs, or else the ability to understand such signs, 

 is impaired or lost. Indeed, aphasic persons are very often incapa- 

 ble of reading or understanding either written or printed words. 

 In very exceptional cases the speaking faculty has been preserved, 

 while the ability to make or to comprehend signs has failed. To this 

 condition the term aphasia certainly does not apply. An aphasic 

 patient now at the Giessen clinic for some weeks presented the odd 

 peculiarity of being unable to open his mouth when told to do so. 

 He would make awkward and vain attempts to open it with his fin- 

 gers ; but the moment a spoonful of food was presented to his lips, 

 the mouth would gape to the verge of its ability. 



We have not as yet any satisfactory explanation of the physiol- 

 ogy of aphasia. Trousseau ascribed the loss of speech to two con- 

 ditions : 1. To partial lack of memory. In such cases the patients 

 do not speak because they cannot remember the words ; but they 

 can still repeat words spoken to them (amnestic form). 2. To for- 

 getting the art of articulation, so that repetition of words spoken to 

 the patient is difficult or impossible to him (atractic form). 



It is very easy to recognize an uncomplicated, well-pronounced 

 case of aphasia ; but the diagnosis of an ill-marked case, or of one 

 combined with other mental disorders, may be very difficult. Hemi- 

 plegia often exists on the side opposite to that of the brain-lesion 

 (hence generally upon the right side) ; and since the aphasia in such 



