January 27, 1888.] 



SCIENCE 



43 



faculty, but that the memory of each kind of mental acquisition 

 was separately organized, and that the cerebral seat of the memory 

 for motor speech- signs was in the third frontal convolution of the left 

 half of the brain. The most startling fact about this discovery was 

 the association of the malady with a lesion in the left half of the brain 

 only. Broca explained this by taking into consideration that we 

 were all organized with a preferred side of the body, and that to 

 be right-handed means nothing else than to have one's best-devel- 

 oped motor centres in the left half of the brain, inasmuch as the 

 fibres cross over in their descent from brain to muscles. In the 

 same way our speech-movements get associated with the left hemi- 

 sphere ; and in left-handed persons the reverse condition may be 

 expected to occur, and has since been found. 



Trousseau substituted the word ' aphasia ' for the disease, leaving 

 Broca's term to denote that particular form of it which he brought 

 to notice : for it was soon afterwards observed that with the loss of 

 speech sometimes went the loss of writing as well, and sometimes 

 not; that, again, the power to write may be lost, and that of speech 

 retained. Other patients could speak and write, but not read ; and 

 others, again, could read, but not speak or write. A complexity of 

 symptoms variously combined have arisen in which order is now to 

 be put. Four types can be distinguished : — 



First Type. — In describing such types, it should be noted, gen- 

 eral and typical symptoms alone can be noticed. The patient, per- 

 haps as a sequence to an apoplectic stroke, sinks into a condition 

 apt to be mistaken for a condition of deafness and idiocy ; but 

 careful observation soon shows that he is sensitive to noises, such 

 as the opening of a door, and even hears the sounds of the human 

 voice. Inferring that he is spoken to, he may attempt to answer, 

 but will say something entirely irrelevant. Gradually appreciating 

 that he is not speaking to the point, he may with some impatience 

 ask you why he cannot understand what you say. He thus shows 

 his ability to express his thoughts, to hear perfectly, and, besides, 

 he reads and writes, plays chess, and is able to do every thing 

 but understand spoken words. Your speech is as an unknown 

 language to him, — just so much sound. What he has lost is the 

 power to get meaning out of sounds ; the slowly acquired associa- 

 tions between the word-sound and the idea are broken down ; his 

 memory for word-meanings is lost. He is not deaf to sounds, 

 but deaf to words, — a ' verbal deafness,' as it is called. We have 

 thus a memory for the meaning of the sounds of words, having its 

 centre in the first temporal convolution of the left half of the brain, 

 and losing its function when that region suffers degeneration. 



Second Type. — Here, again, the cause may be an apoplectic 

 stroke, which, after the immediate effects have passed off, leaves 

 the patient in an apparently normal condition. He may prepare to 

 attend to his business affairs ; will perhaps sit down to write a let- 

 ter ; does so, and, remembering that he omitted something, takes 

 the letter out to read it again. To his surprise, he cannot do so. 

 He takes out his account-books, and finds he cannot read them ; 

 he picks up the newspaper, and again it says nothing to him. This 

 patient hears, understands, and speaks : he is not aphemic in 

 Broca's sense. Moreover, he can write ; but his writing shows 

 that it was written as though writing in the dark, guided by the 

 muscle-feelings of the hand alone. He cannot read what he has 

 just written, nor can he write from copy. His own name, that has 

 been well impressed upon his motor centres, he writes very well, 

 but he cannot read it. A book or a manuscript is to him as though 

 it were written in Chinese. The disease here, then, is in the loss 

 of the memory for the visual word-signs : the patient is not blind, 

 but ' word-blind.' The remembrance of the forms of letters as re- 

 tained by the movements executed in making them is intact, the 

 lesion being a purely visual one. The brain lesion in such cases is 

 quite definitely made out. It is in the second parietal convolution 

 or inferior parietal lobule, behind and above the lesion in word- 

 deafness, and, like it, is confined to the left hemisphere. 



Third Type. — Here the patient can speak, can read manuscript or 

 print, but he cannot write. He takes the pen in hand to write a 

 word, knows what he ought to write, how it would look if written, 

 but he cannot write it. He has lost the memory of the movements 

 necessary to form the letters. The association between the move- 

 ments made in writing and the word has been lost. He is not 

 word-blind or word-deaf, but the tnoior word-sense is defective : 



he is ' agraphic,' as the term goes. A more careful observation 

 shows how closely his malady is limited to this loss. He can use 

 his hands dexterously for all other purposes ; he can even draw and 

 copy from a drawing. He can in this way copy script or print, but 

 he draws the letters slowly, as we would copy a Chinese word. 

 We see, then, that the auditory, the visual, and the motor elements 

 of the word are to some extent independent, and that the memory 

 for one of these may be lost while the others are retained. We 

 may expect to find a localization for the motor defect, as for the 

 others : but, owing to the fact that the disease seldom occurs with- 

 out other complications, the localization is not as certain. Yet the 

 bulk of the evidence points to the posterior portion of the second 

 frontal convolution as the centre disturbed in aphasia. The lesion 

 is again confined to the left half of the brain, and, to complete the 

 connection of this with the phenomena of right-handedness, such 

 patients can learn to write with the left hand by submitting them- 

 selves to a process similar to that gone through with in learning to 

 write in youth. They thus cultivate the right hemisphere of the 

 brain. 



Fourth Type. — This is the type described by Broca as aphemia, 

 and now called motor aphasia. The loss here is the link between 

 the idea and the appropriate movements of tongue, etc., necessary 

 to make the sounds of words. Often the patient retains a few 

 phrases used on all occasions : in one case it was ' cousisi,' in an- 

 other ' monomomentif.' The poet Baudelaire, when thus affected, 

 would constantly say ' ere nom.' Here the power of hearing and 

 understanding is retained, writing and reading are intact, and 

 speaking alone has dropped out. The lesion is in the third frontal 

 convolution, mainly the posterior portion, of the left side of the 

 brain. 



These pathological states suggest that individual differences with 

 regard to the prominence of these several word-memories in our 

 minds should be discoverable, and that the brain-centre corre- 

 sponding to the preferred memory should be more highly developed 

 than the others. It has often been observed that to many persons 

 the eye is the chief avenue of knowledge. Extreme instances of 

 this faculty, such as artists copying portraits from memory, and 

 calculators doing their work upon an imaginary blackboard, are 

 well known ; but, confining ourselves to the memory for written or 

 printed words, we find an excellent type of this faculty in a case 

 recorded by Charcot. A gentleman of great culture and experience 

 had the power of reading pages of his favorite authors from the 

 visual images of the printed page. Two or three readings of a pas- 

 sage were sufficient to fix it in his memory. If he wanted a letter 

 in a voluminous correspondence, he at once thought of its appear- 

 ance ; and so, too, with regard to all visual experiences in general. 

 For music and other auditory occupations he had no taste. The 

 importance of the case is doubled by the fact that through disease 

 this faculty was lost, and he had to resort to his auditory memory, 

 and cultivate it by having things read to him, and in other ways. 

 He could not remember what he had seen, be it words or other 

 objects ; and, in short, from being a ' visual-worded ' and ' visual- 

 minded ' man. he was forced to become an 'auditory-worded ' and 

 'auditory-minded' one. This type of mind is common, and many 

 persons have the habit of seeing the picture of the page from which 

 they quote, the appearance of their manuscript, and so on. Un- 

 fortunately we have no autopsies of normal persons who had been 

 marked cases of this type, to see whether in them the second pari- 

 etal convolution was especially developed. Passing to the auditory 

 type of mind, one could again easily find extreme cases, and note 

 many instances in which what is heard, and especially in words, 

 is most readily and deeply impressed. Persons to whom writing is 

 easier than speaking, whose thoughts flow off the end of their pens 

 and not of their mouths, may be classed among the ' graphic- 

 motor ' type. Deaf-mutes are apt to develop this faculty in another 

 direction, and think in terms of hand-movements. There remains 

 the ' motor-verbal ' type. Strieker describes himself as of this type, 

 and tells how he thinks in terms of the muscle-feelings in the or- 

 gans of articulation. Such persons talk to themselves when they 

 think, and are well represented by a character in a French tale, 

 who could not compose unless imagining himself formally deliver- 

 ing what he was dictating. Unlike the other cases, there is here 

 some anatomical corroboration ; and a collection of the brains of 



