386 



NATURE 



[August 21, 1890 



and will bring his "Glossary" into harmony with the 

 present condition of science, his " Freshwater Algae '' 

 will have a still higher claim to a permanent place in 

 botanical literature. Alfred W. Bennett. 



APHASIA, OR LOSS OF SPEECH. 



On Aphasia, or Loss of Speech, and the Localization of 

 the Faculty of Articulate Language. By Frederic 

 Bateman, M.D., F.R.C.P., Senior Physician to the 

 Norfolk and Norwich Hospital, &c. Second Edition, 

 greatly enlarged. (London : J. and A. Churchill, 

 1890.) 



THE subject of aphasia has always been, and still is, 

 not only of the greatest interest, but also of the 

 greatest difficulty. Its interest is, of course, largely due to 

 the fact that a study of partial or total loss of language 

 may not only help in an analysis of language itself, but 

 also may throw light on the exact anatomical situation of 

 that function which has been said to set up an insur- 

 mountable barrier between man and the lower animals. 

 Its difficulty is greatly increased by the fact that each 

 investigator seems to define it in a different way. For 

 instance, in the book whose title is given above, which is 

 a second and greatly enlarged edition of Dr. Bateman's 

 " Aphasia," first published twenty years ago, two entirely 

 different definitions are accepted as correct. In the 

 opening chapter aphasia is defined as " the term which 

 has recently been given to the loss of faculty of language, 

 and of the power of giving expression to thought, the 

 organs of phonation and of articulation, as well as the 

 intelligence, being unimpaired." On p. 1 54, however. Dr. 

 Bateman states that he will " employ the term as a title 

 for the whole group of disorders of speech, thus embracing 

 n.ot only the loss, but all the various degrees of impair- 

 ment, of that faculty." This latter definition will, of 

 course, denote an enormous number of affections, such as 

 all the losses or alterations of speech due to gross cerebral 

 lesions, to insanity, diseases of the medulla, cretinism, 

 deaf-mutism, chorea, and so forth, many of which have 

 hardly been touched upon in this work. The former 

 definition also, in spite of its greater connotation, would 

 include such diseases as deaf-mutism, which is hardly a 

 form of true aphasia. 



It is, perhaps, better to limit the term aphasia much 

 more than either of the above definitions would 

 allow. As Ross has so well shown in his small but 

 highly philosophical work, " Aphasia," the mechanisms of 

 speech must include {a) the "receptive organs" — that is, 

 the eye, the ear, and the touch (as in reading from 

 raised letters) ; {b) the apperceptive centres in the 

 brain, where the various sensory phenomena are appre- 

 ciated as language — that is, the angular gyrus and 

 supra-marginal convolutions for written language, and 

 the first temporo-sphenoidal convolution for spoken 

 language ; (6') the emissive motor centres in the brain at 

 the posterior end of the third left portal convolution 

 (Broca's convolution), from which discharges are sent 

 through the internal capsule to the various organs of pho- 

 nation ; and {d) the executive organs, including the nerve 

 nuclei in the medulla, the peripheral nerves from these, 

 and the various muscles of the larynx, pharynx, and 

 NO. 1086 vol,. 42] 



tongue. Now of these four sets of organs the first and 

 last should not be included in considering true aphasia 

 so that we should not include as aphasia such disorders 

 of speech as arise from deafness, blindness, bulbar 

 paralysis, or paralysis or other diseases of the larynx or 

 tongue. The two remaining groups, (^b) and if), alone re- 

 main, and the organs of both are situated entirely in the 

 brain, so that we can shortly define aphasia as a disorder of 

 speech due to cerebral disease, the intellect being un- 

 affected. It can, moreover, be seen to be roughly of two 

 kinds — sensory when the apperceptive organs are affected, 

 and motor when the emissive organs are affected. Now 

 on these points Dr. Bateman has not been sufficiently 

 explicit, with the result that some subjects have been 

 included in his work which might well have been left out. 



Aphasia may be divided, moreover, as regards causation, 

 into organic where there is a distinct gross lesion, and 

 functional where no known lesion is present. Of the 

 functional causes, hysteria is by far the most common, and 

 is generally the cause of those apparently anomalous cases 

 where speech suddenly vanishes, only to return in as 

 sudden a manner. 



Nearly the first hundred pages of the book contain a 

 most excellent account of the history of aphasia from the 

 earliest times ; but we regret to notice that while great 

 stress is laid on cases reported more than fifty years agO; 

 when nervous diseases were so little understood and 

 when the examination of aphasic patients was most in- 

 complete, yet the later and most thorough accounts of 

 aphasia are noticed very slightly or not at all. Thus, 

 although we find some slight references to Kussmaul's 

 classical work, and also a slighter account of the works 

 of Ross and Broadbent, Wernicke and Lichtheim are 

 altogether neglected. And be it remembered that these 

 names stand out pre-eminently as writers on this difficult 

 subject. 



All through this work there is an undercurrent of dis- 

 belief in any possibility of localizing the cerebral situation 

 for speech, and after considering all the various views of 

 localization, from that of Schroeder van der Kolk, who 

 localized it in the corpora olivaria of the medulla oblon- 

 gata, to that of Broca, with his localization in the posterior 

 part of the third left frontal convolution, the author 

 finally agrees with Kussmaul in saying that " a simple 

 centre of language or seat of speech does not exist in the 

 brain, any more than a seat of the soul exists in a single 

 centre." Indeed, as the author's cases (to which I shall 

 refer immediately) show, he seems to take extraordinary 

 pains to satisfy his readers that Broca's convolution is 

 not the seat of language, as in many cases of aphasia it is 

 entirely unaffected. Nowadays, however, a neurologist 

 does not attempt to fix on Broca's convolution alone as 

 the seat of language, but says that either the supra- 

 marginal or angular gyri, or the first temporo-sphenoidal 

 convolution (all on the left side), or their connections 

 with the motor region, are affected, as a rule, in sensory 

 aphasia ; or Broca's convolution, or its connections through 

 the internal capsule with the medulla, are affected in 

 motor aphasia. We know now sufficiently well that a 

 lesion at the front of the anterior lobes, or in the motor 

 area proper, would not be accompanied by aphasia, just 

 as we know that a lesion in the other regions mentioned 

 would almost certainly be accompanied by aphasia. 



