574 PHYSIOLOGY. 



Motor Aphasia (Aphemia). If he can speak voluntarily, can he 

 repeat words or read aloud? If he cannot, he has aphemia. 



Agraphia. Supposing the patient can write voluntarily, can he 

 write from dictation or from copy ? If he cannot, he has agraphia. 



A symptom found in all cases of aphasia: if he cannot write 

 voluntarily, because of inability to remember words, but can write 

 from dictation, it is sensory agraphia. If he cannot write either 

 voluntarily or from dictation, it is motor agraphia. 



If he uses one word for another, so that the result is unintelli- 

 gible, then there is paraphasia. 



If he writes, and he uses one word for another, so that it is 

 unintelligible, then para-agraphia. 



Paraphasia and paragraphia are symptoms of conduction apha- 

 sia, lesion of commissural fibers, and the lesion is ordinarily in the 

 island of Eeil or the convolutions about the fissure of Sylvius. 



Motor Aphasia. If the patient can read silently, write volun- 

 tarily, write from dictation, copy and hear and understand spoken 

 words, but cannot speak voluntarily, repeat words or read aloud, then 

 the lesion is in Broca's convolution, third frontal (motor aphasia, 

 aphemia). 



If the patient can hear and understand spoken words, read and 

 understand written or printed words and copy, but cannot speak vol- 

 untarily, repeat words, read aloud, write voluntarily or from dicta- 

 tion (aphemia plus agraphia), there is a lesion of the third left frontal 

 convolution. This is the most frequent form of aphasia. 



Visual Aphasia. If the patient can speak voluntarily and under- 

 stand spoken words, but cannot understand written or printed words, 

 write voluntarily or from dictation or from copy (visual aphasia plus 

 agraphia), there is a lesion in the angular gyrus and supramarginal 

 lobe. 



Auditory Aphasia. If the patient can speak voluntarily, read 

 intelligently, and write voluntarily, but cannot understand spoken 

 words, repeat words or write from dictation (auditory aphasia), then 

 there is a small subcortical lesion of the first and second temporal 

 convolutions. (Butler's Diagnostics). 



