106 THE TREATMENT OF DISEASES. 



grammatical framework of the sentence seldom suffers. It has been noticed, too, 

 that substantives only are substituted for substantives, verbs for verbs, numerals 

 for numerals, and proper names for proper names. The words with which the 

 greatest difficulty is experienced are usually nouns. 



Sometimes a patient when aphasic may repeat everything that is said to him, 

 and never say a word besides. A curious circumstance is that under strong emotion 

 or excitement a patient may be able to swear, although at other times he cannot 

 utter a word. Swearing is with many people almost an involuntary act, and it is 

 remarkable that disease should draw a line between the emotions and the intellect, 

 between signs of feelings and signs of ideas. Another fact worth mentioning is 

 that aphasic persons who cannot talk can often sing quite correctly. 



Certain aphasic patients can write, while others fail to do so ; those who are 

 capable of the act occasionally write sense, frequently nonsense, but more frequently 

 either unintelligible characters, or distinct but unconnected words. Sometimes the 

 patient may be able to copy manuscript, or even to convert printed sentences into 

 ordinary writing, when he could not write the same words if dictated to him. 

 Curiously enough an aphasic who is unable otherwise to write will often readily 

 sign his own name. Some aphasics can point out letters that are named to them, 

 whilst others fail to do so. If they be given a children's bone or wooden alphabet, 

 they make curious attempts to spell a word, and often enough can achieve no 

 more than a dim yet perceptible resemblance to it. Thus a man named James 

 Sinimonds put together the letters JICMNOS in a vain attempt to represent his 

 own name. 



As a rule, in aphasia there is some impairment of intelligence, but usually it 

 is not very great. The aphasic recognises his friends, remembers where he lives, 

 and can often play correctly at cards, backgammon, dominoes, or any game of 

 skill or chance with which he may be acquainted. He is not only able to play 

 his own game, but is quite capable of cheating, should he be desirous of so doing. 

 The case is recorded of a Russian gentleman resident in Paris, who spoke French 

 like a native, yet after an attack of aphasia he was unable to utter a word of that 

 language. When questioned, he smiled and said " Da," a Russian word meaning 

 " Yes." He was unable to construct even part of a sentence in his own language. 

 When shown a spoon he could make signs showing its use, yet had forgotten its 

 name both in Russian and French. Nevertheless, he could play at whist correctly, 

 and noticed any errors of his adversary by making a gesture. 



With regard to the general symptoms of aphasia, we should state that usually 

 the deprivation of speech occurs suddenly. Perhaps in a short time two or three 

 words can be uttered, which, as we have seen, are then used in reply to all questions. 

 The face is intelligent, and the movements of the lips and tongue and palate 

 are in no way interfered with. In cases in which aphasia is not accompanied by 

 paralysis of the limbs, recovery often occurs quite suddenly. It is believed by 

 many that transitory attacks of aphasia are by no means uncommon. 



There is very little difficulty in recognising the existence of aphasia. Hysterical 

 women sometimes pretend that they are unable to speak, but here the most super- 

 ficial examination will detect the real nature of the complaint. Impostors some- 



