CEREBRAL LOCALIZATION 695 



power of associating the various sensory impressions is relatively normal, 

 although he absolutely fails in his attempts to give verbal expression to 

 these concepts. Indee'd, a person of this kind may be told the missing 

 words repeatedly without being able to utter them, for the reason that 

 his power of forming words has been lost. It is true, however, that 

 any statement which definitely asserts that there is no impairment of 

 the intellectual faculties in motor aphasia, should be accepted with 

 reserve, because aphasias unaccompanied by a lowering of other 

 faculties are not common. A pure motor aphasia is designated as 

 aphemia. The real determining factor of the loss of intelligence, 

 associated with aphasia, is the cause and extent of the lesion, because it 

 is more than probable that a degenerative process affecting the frontal 

 convolutions, most generally passes beyond the confines of this region 

 and also involves more distant areas of the cerebrum. Thus, while 

 these patients may deport themselves reasonably well and even con- 

 tinue to transact ordinary business, their difficulty in speech is in 

 many cases associated with others, such as an at least partial paralysis 

 of the skeletal muscles, showing an involvement of the motor area 

 (hemiplegia), or an anarthria, proving an impairment of the motor 

 power of expression (Marie). The latter condition usually indicates a 

 lesion of the white matter of the external capsule as its winds around 

 the lenticular nucleus. 



In many cases of aphasia, we also observe a loss of the power of 

 writing (agraphia), or a loss of the power of making purposive move- 

 ments of a familiar kind (apraxia). The latter condition may be 

 tested by handing the patient a comb, drinking glass, matches, or other 

 articles and noticing whether he knows how to use them. Apraxia 

 may be sensory or motor in its character. 



This discussion inadvertently leads us to the further consideration 

 of the data supplied by Bouillaud and Broca in support of the contention 

 that the speech center is located in the left inferior frontal convolution. 

 It has been stated that this is true only in right-handed persons, ^.e., in 

 about 95 per cent, of people, and that this center is situated on the right 

 side in left-handed individuals (Noison, 1862). Moreover, it is a 

 common experience that reeducation is difficult to accomplish in the 

 adult, but not in children. ^ This fact seemsjto suggest that the destruc- 

 tion of the aforesaid area in children, allows the elements in the opposite 

 frontal lobe to develop into a true center. Very difficult to understand 

 are those cases which prove that aphasia may be present in an individual 

 whose inferior frontal lobe was shown at necropsy to be free from 

 lesions . Again, it has been demonstrated that aphasia may be absent in 

 cases of undisputed destruction of Broca's area. ^ Montier presents the 

 records of 108 trustworthy cases. Of these, 19 support Broca's conten- 

 tion, while 84 are against it. , In 57 of them motor aphasia was present 

 in spite of the fact that Broca's area was intact, while the others showed 



1 Gowers, Diseases of the Brain, London, 1885. 



2 Monakow, Gehirnpathologie, 1906, and Collier, Brain, 1908. 



