PHYSIOLOGICAL TOPOGRAPHY OF SURFACE OF CEREBRUM. 797 



1. Ataxic aphasia, or psychomotor aphasia, is loss of the power of speech 

 in consequence of inability to execute in a coordinate manner the movements 

 necessary for speech. Under such circumstances, the ability has been lost to 

 form a conception of the movements for speech, as well as the power also of recog- 

 nizing the position of the organs of speech. The intention to speak causes in- 

 coordinate grimaces and the utterance of inarticulate sounds. Therefore, the 

 patients are unable to repeat what is spoken to them. At the same time, the 

 mental processes necessary for the faculty of speech are wholly preserved, and all 

 words are probably retained in memory, so that some are still able to express 

 themselves in writing. If, however, the delicate movements acquired by edu- 

 cation that are necessary for writing are lost in consequence of a lesion of possibly 

 a special center at the extremity of the second frontal convolution there results 

 at the same time ataxic agraphia, that is an inability to perform the movements 

 necessary for writing. The intention to record thought on paper results only 

 in an illegible scrawl. At times even pantomime-speech may be interfered with 

 under such circumstances am-im-ia. There may be also a purely functional hys- 

 terical aphasia. 



2. Amnesic aphasia or psycho sensor ial aphasia, a condition in which the 

 memory of words is lost. Occasionally, only certain groups of words are lost, 

 or even only portions of certain words, so that these may be produced in a de- 

 formed or partial manner. The movements necessary for speech are intact. 

 Therefore, the patient is capable of repeating at once all that is spoken to him 

 or of writing on dictation. In polyglot individuals all forms of language are lost 

 and not only one. Amnesic aphasia has been observed in connection with de- 

 struction of the first temporal convolution on the left. There is also a combined 

 form of ataxo-amnesic aphasia. In another variety of amnesic aphasia while 

 the words are still retained in memory, they cannot be expressed fluently, that 

 is the association of word and conception is inhibited. The failure to recall 

 persons and the names of objects is, particularly in advanced age, a phenomenon 

 observed within physiological limits, but which eventually may terminate in senile 

 amnesia. Kussmaul has, further, included among the cerebral derangements of 

 speech the following special varieties: 



3. Paraphasia, or the inability to associate correctly the word-images with 

 their conceptions, so that, instead of intelligent word-pictures, reversed or wholly 

 incomprehensible word-pictures are aroused. There occurs to a certain degree 

 permanent confusion of speech. 



4. Agrammatism and acataphasia, or the inability correctly to form words 

 grammatically and to arrange them syntaxically in sentences. In addition there 

 may be: 



5. Abnormal slowness of speech, bradyphasia, or abnormal acceleration of speech 

 (tumultus sermonis), a lisping or abnormally slow speech, which likewise are de- 

 pendent upon cortical disorders. Derangements of speech that are 'dependent 

 upon affections of the peripheral nerve or the muscles of the organs of voice and 

 speech have been described on pages 617, 697 and 713. 



The faculty of musical expression may be preserved or lost in connection with 

 aphasia amusia, note-blindness, sound-deafness; it is perhaps represented by 

 a special cortical center, possibly situated in the posterior portion of the first 

 and second temporal convolutions. 



The cortical thermic center for the extremities discovered by Eulen- 

 burg and Landois is at the same time, related to the localization of the 

 motor points. There are observations on record of injury or degenera- 

 tion in these areas, with inequality in the temperature on the two sides 

 of the body. After the existence of paralysis for a considerable length 

 of time the temperature of the affected members, which at first is higher, 

 may become lower than that of the unaffected side. Stimulation of this 

 area gives rise also to increase in the blood-pressure, as, for example, in 

 connection with epileptic convulsions. Wounds made for the exposure 

 of the brain therefore usually bleed more freely during such an attack. 

 According to Schiiller the center for the entire contralateral half of the 

 body is situated just in front of the precentral gyrus in the second tem- 

 poral convolution. 



