770 VOLUNTAEY MOVEMENTS. [BOOK IIL 



we recognize that he is attempting to utter the right words in 

 the right sequence, but that his efforts are frustrated by imper- 

 fect coordination or imperfect muscular action ; his speech is 

 ' thick,' the syllables are blurred and the like. Disease of the 

 bulb at times leads to imperfect speech of this kind in which the 

 imperfection may be recognized as due to the lack of proper 

 coordination of motor impulses. The affection of speech, known 

 as ' aphasia,' which is caused by lesions of the cortex is of a dif- 

 ferent character, and the forms of imperfect speech caused by 

 bulbar disease have justly been distinguished from true aphasia 

 by the use of other terms. Cases of complete aphasia in which 

 all power of speech is lost, do little more than help us to ascer- 

 tain the topographical position in the cortex of the ' speech ' area, 

 but cases of partial aphasia are especially instructive. Without 

 attempting to go into the details of the subject and into the 

 many considerations which have to be had in mind in dealing 

 with it, for there are different kinds of aphasia, we may venture 

 to say that the striking feature of partial aphasia is the failure 

 to say certain words or syllables, and the tendency to substitute 

 some wrong word or syllable for the right one. The words or 

 syllables which are uttered are rightly pronounced without defect 

 of articulation ; and in many cases, though the right word can- 

 not be produced as a direct effort of the will, it may be uttered 

 under the influence of an emotion, or indeed sometimes as the 

 result of some psychical processes more complex than those in- 

 volved in the mere volitional effort to say the word. An instruc- 

 tive case is recorded of a man suffering from slight aphasia, who 

 after several failures to say the word ' no ' by itself, at last said, 

 ' I can't say no, sir.' 



From the phenomena of partial aphasia we may on the one 

 hand draw the deduction that the cortical speech area does not 

 carry out the whole of the coordination of the impulses involved 

 in articulation. That coordination is exceedingly complex, and 

 we ought perhaps to recognize in it more than one degree or 

 kind of coordination. We must of course admit that a great 

 deal of coordination of a certain kind takes place in the cortex, 

 for the bulb cannot by itself be made to speak. But the failure 

 of articulation in disease of the bulb shews that a certain amount 

 of coordination takes place there also ; for the affections of speech 

 due to bulbar disease are not the same as those resulting from 

 the mere loss of this or that muscle or nerve. The word spoken 

 does not start, so to speak, ready made in the cortex ; it is not that 

 a group of impulses start from the cortex with their coordination 

 fully achieved, and pass along certain nerve fibres to certain 

 muscles making their way without change through the tangle of 

 the bulb, as if this were merely a bundle of lines offering paths 

 for, but exercising no influence over the impulses. We must 

 rather suppose that something takes place in the cortex of the 



