APHASIA. 



711 



The following forms of aphasia may be distinguished : 



1. Ataxic aphasia (or the oro-lingual hemiparesis of Ferrier), i.e., the loss of speech owing 

 to inability to execute the various movements of the mouth necessary for speech. Whenever 

 such a person attempts to speak, he merely executes inco-ordinated grimaces and utters inarti- 

 culate sounds. [The muscles concerned in articulation, however, are not paralysed, but there 

 is an absence of co-ordination of these muscles due to disease of the cortical centre.] Hence, the 

 patient cannot repeat what is said to him. Nevertheless, the psychical processes necessary for 

 speech are completely retained, and all words are remembered ; and hence, these persons can 

 still give expression to their thoughts graphically or by writing. If, however, the finely 

 adjusted movements necessary for writing are lost, owing to an affection of the centre for the 

 hand, then there arises at the same time the condition of agraphia, or inability to execute those 

 movements necessary for writing. Such a person, when he desires to express his ideas in 

 writing, only succeeds in making a few unintelligible scrawls on the paper. Occasionally such 

 patients suffer from loss of the power of imitation or the execution of particular movements of 

 the limbs and body constituting pantomime speech or amimia {KussmauT). 



2. Amnesic Aphasia, or Loss of the Memory of Words. Should the patient, however, hear 

 the word, its significance recurs to him. The movements necessary for speech remain intact ; 

 hence, such a patient can at once repeat or write down what is said to him. Sometimes only 

 certain kinds of words are forgotten, or it may be even only parts of certain words, so that onl) r 

 part of these words is spoken. [Nouns and proper names usually go first.] Cases of amnesic 

 aphasia, or the mixed ataxic-amnesic form of disturbance of speech, point to a lesion of the 

 third frontal convolution and of the island of Reil on the left side. Another form of amnesic 

 aphasia consists in this, that the words remain in one's memory but do not come when they 

 are wanted, i.e., the association between the idea and the proper word to give expression to it 

 is inhibited (Kussmaul). It is common for old people to forget the names of persons or proper 

 names ; indeed, such a phenomenon is common within physiological limits, and it may ulti- 

 mately pass into the pathological condition of amnesia senilis. Amongst the disturbances of 

 speech of cerebral origin, Kussmaul reckons the following : 



3. Paraphasia, or the inability to connect rightly the ideas with the proper words to express 

 these ideas, so that, instead of giving expression to the proper ideas, the sense may be inverted, 

 or the form of words may be unintelligible. It is as if the person were continually making a 

 " slip of the tongue." 



4. Agrammatism and ataxaphasia, or the inability to form the words grammatically and to 

 arrange them synthetically into sentences. Besides these, there is 



5. A pathological slow way of speaking (bradyphasia), or a pathological and stuttering way 

 of reading (tumultus sermonis), both conditions being due to derangement of the cortex 

 {Kussmaul). The disturbances of speech depending essentially upon affections of the peripheral 

 nerves, or of the muscles of the organs of the voice and speech, are already referred to in 

 319, 349, and 354. 



[In word-blindness, the person cannot name a letter or a word, so that he can- 

 not understand symbols, such as printed or written words, or it may be any familiar 

 object, although he can 

 see quite well, while he 

 can speak fluently and 

 write correctly.] 



[In word-deafness, 

 the person hears other 

 sounds and is not deaf, 

 but he does not hear 

 words.] 



[The study of aphasia 

 in its various forms is 

 simplified by a study of 

 the mode of acquisition of 

 language by a child. The 



Fig. 494. 



Fig. 495. 

 child hears spoken words ^ s - *94, 495. Schemes of aphasia. A, centre for auditory images; 

 and obtains auditory me- M ' for motor images ; B, perception centre ; Oc, eye ; E, reading 

 mories or impressions of centre ; 1 to 7, lesions {Lichtheim). 



these sounds (called by Lichtheim " auditory word-representations"), and this must form 

 the starting-point of language, and by and by it begins to co-ordinate its muscles to pro- 

 duce sounds imitative of these. Thus we have two centres, one for "auditory images" 

 (fig. 494, A), and the other for " motor images" (fig. 494, M), and these two must be con- 

 nected, thus establishing a reflex arc. There is a receptive and an emissive department as 



