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On Aphasia, or Loss of Speech in Cerebral Disease

Published online by Cambridge University Press:  19 February 2018

Frederic Bateman
Frederic Bateman*
Affiliation:
Norfolk and Norwich Hospital
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Extract

In the first two parts of this essay I entered into the subject of the bibliography of aphasia, as illustrated by the French, German, Dutch, British, and American writers; the third part contains a detailed account of the clinical history of cases that have fallen under my own immediate observation; the fourth treats of the different forms and varieties in which loss or lesion of articulate language is met with in practice; whilst in the fifth part I have considered the subject in reference to the question of Cause, Diagnosis, Prognosis, and Treatment.

Type
Part 1.—Original Articles
Information
Journal of Mental Science , Volume 15 , Issue 71 , October 1869 , pp. 367 - 393
Copyright
Copyright © Royal College of Psychiatrists, 1869 

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References

∗ Those who may desire more detailed information as to the various theories of the seat of speech which were in vogue before the time of Gall, I would refer to an extremely interesting series of papers now being published by Dr. Hunt in the Anthropological Review.Google Scholar

∗ Gall's labours would undoubtedly have met with a more hearty recognition from his contemporaries, had not the Austrian priesthood raised the cry of “materialism” as applied to his doctrines. The great German psychologist had no such heterodox notions as his adversaries maliciously attributed to him, for as Hufeland philosophically observes, “ he was employed in analysing the dust of the earth of which man is formed, not the breath of life which was breathed into his nostrils.” Google Scholar

As in Gall's days so in ours, this very indefinite and unmeaning word “materialism” is used as a kind of psychological scare-crow to frighten all those who are endeavouring to trace the connexion between matter and mind. Surely there is nothing contrary to sound theology in assigning certain attributes or functions of an intellectual order to certain parts of our nervous centre; the cerebral localisation of our divers faculties, and the plurality of our cerebral organs, strike no blow at the great principle of the moral unity of man. The same power that caused the earth “like a spark from the incandescent mass of unformed matter, hammered from the anvil of omnipotence, to be smitten off into space” this same power, surely, could just as well ordain that a multiplicity of organs should be necessary to the full development of man's mental faculties, as that the manifestation of them should depend upon the integrity of one single organ.Google Scholar

∗ Gazette Hebdomadaire de Médecine et de Chirurgie, July 22, 1864.Google Scholar

† Lecons sur la Physiologie générale et comparée du Systême Nerveux, p. 495.Google Scholar

∗ Since the above was penned, my attention has been called to the latest publication on the anatomy of the medulla oblongata in this country, in which the author, Dr. Lockhart Clarke, mentions two cases of aphasia, in each of which one of the olivary bodies was diseased, being in the one case atrophied, and in the other the seat of a former clot. In both these instances there were numerous and extensive lesions in other parts of the brain, therefore—as Dr. Clarke also admits—they by no means prove that the loss of speech was due to the diseased condition of the olivary bodies.–-“Researches on the Intimate Structure of the Brain.” Philosophical Transactions 1868, Pt. I., p. 312.Google Scholar

† Vide Journal of Mental Science, Jan., 1868, pp. 528, 530.Google Scholar

∗ Cruveilhier, , Anatomie Pathologique, 8e Livraison, pl. 6.Google Scholar

† This limitation of the anterior lobe is correct only as far as the orbital convolutions are concerned, for a glance at the plate, at the end of this essay, will show that above the orbital portion the anterior lobe extends very much further backwards.Google Scholar

∗ Dax's, Dr. conclusions were embodied in a communication to the medical congress held at Montpellier, in the year 1836, the title of his paper being—Lésions de la moitié gauche de l'encéphale coincidant avec l'oubli des signes de la pensée. In 1863 his son, Dax, G. Dr., presented a memoir to the Academy of Medicine of Paris, in which, whilst supporting the views of his father as to the seat of speech in the left hemisphere, he confined it to more narrow limits, namely, the anterior and external part of the middle lobe.Google Scholar

∗ Gazette des Hôpitaux, Jan. 25, 1868.Google Scholar

∗ Dictionnaire Encyclopédique des Sciences Médicales, Article “Aphasie,” par Jules Falret, p. 628.Google Scholar

† Ibid, p. 628.Google Scholar

‡ I give the leading features of this case in Lelut, M. s own words. It affords another illustration of the manner in which cases are distorted to suit particular theories, for on referring to the original description as it appeared in the Journal Hebdomadaire de Médecine, it seems that instead of complete disorganisation of the left hemisphere, the lesion was limited to the posterior and middle lobes, and the report goes on to say that “the anterior lobes were very well developed and their convolutions had the usual proportions.” In reference to the question we are now considering this is, doubtless, not the only instance in which a clinical observation has been misinterpreted according to the fancy of individual critics. Lelut, M. has chosen to cite it as militating against Dax's theory; surely Bouillaud and Broca have a better right to claim it as pre eminently tending to support their views.Google Scholar

∗ Since the above was written, Charcot, M. has informed me that he has met with two cases of aphasia without hemiplegia, in which the only lesion found after death was obstruction from atheromatous degeneration of the branch of the middle cerebral artery which supplies the third left frontal convolution.Google Scholar

† Dr. Long Fox, of Bristol, has observed a case of syphilitic disease of the left frontal convolutions involving Broca's region, the power of speech being unimpaired. Lond Hosp. Reports, vol. iv., p. 350.Google Scholar

∗ Vide Journal of Mental Science, Oct., 1868, p. 345.Google Scholar

∗ Cyclopedia of Anatomy and Physiology, vol. iii., p. 696.Google Scholar

† Dr. Moxon considers that education is unilateral, that the brain becomes unsymmetrical in higher and more intelligent animals, and reaches its greatest want of symmetry in man, whose early life is spent in the acquirement of what he affirms to be one-sided educational developments.—British and Foreign Medico-Chirurgical Review, vol. 37, p. 489.Google Scholar

‡ According to Dr. Boyd's statistics, which are based on nearly 800 cases observed at the Marylebone Infirmary, the weight of the left hemisphere almost invariably exceeded that of the right by at least the eighth of an ounce.—Philosophical Transactions, 1861, vol. 151, p. 241.CrossRefGoogle Scholar

∗ Since the above was written, Dr. Broadbent has kindly favoured me with a private communication in reference to his recent researches as to the course of the fibres of the brain, so far as his observations bear upon our subject. Dr. Broadbent's dissections shew that the structure of the third frontal convolution is peculiar, inasmuch as it receives fibres from a greater variety of sources than any other convolution; and he adds that although this anatomical fact does not throw any particular light on the function of the third frontal convolution, it seems to indicate that it is an important part of the hemisphere. In comparing the two sides of the brain, Dr. Broadbent has usually found the third frontal convolution larger on the left side than on the right, and in the brain of a deaf and dumb woman, he noted that this gyrus was small on both sides, and especially on the left.Google Scholar

∗ St. George's, Hospital Reports, 1867, p. 111.Google Scholar

† On looking over the published cases of ligature of the common carotid artery, I find that one of the earliest instances is one where the left common carotid was tied in 1815, by Mr. Dalrymple, the well known Surgeon of the Norfolk and Norwich Hospital, for aneurism by anastomosis of the left orbit. In this case speech seems not have been affected, for it is stated that “a few minutes after the patient was placed in bed, she declared that her head no longer felt like her old head, as the noise by which she had been so ong tormented had now ceased.”—Medico-Chirurgical Transactions, 1815. v. 6.Google Scholar

‡ Lancet, March 21, 1868.Google Scholar

§ Medica Times, Jan. 27, 1866.Google Scholar

∗ At the discussion on aphasia which took place at the Norwich meeting of the British Association, Professor Broca alluded to the circumstance that all birds perched on the right leg: Dr. Crisp, on the other hand, said that this peculiarity was confined to Grallæ, and he believed it was a question of equilibrium, and that the bird was compelled to take this position from the greater weight of the liver.Google Scholar

† A distinguished French anthropologist, M. Coudereau, says that articulate language in man is neither an innate nor an exclusive faculty; that man acquires the faculty of speech by his memory, labour, and imitation—the parrot does no more; that from a linguistic stand-point, this faculty is in its nature identical in man and animal.Google Scholar

∗ The above is an extract from an autograph letter with which Professor Vogt has favoured me. In this communication he expresses a doubt whether we shall ever be able satisfactorily to assign “the divers functions” which compose language, to special parts of the brain, until we have a physiological analysis of articulate language, similar to that which Helmholtz has given of sight and hearing.Google Scholar

∗ Recherches expérimentales sur les fonctions du cerveau. Journal de Physiologie, tom. x., p. 49.Google Scholar

† Ibid, p. 85.Google Scholar

∗ Medical Times, Feb. 22nd and March 15th, 1862. There are many other points in Dr Rolleston's paper which, although having no direct bearing upon speech, afford a collateral aid to that subject, and it is impossible to overrate the value of the talented Oxford Professor's researches in this direction.Google Scholar

† Comparative Anatomy and Physiology of the Vertebrates, vol. iii., p. 138.Google Scholar

∗ With the view of verifying the accuracy of this statement, M. Broca examined the heads of thirty-two house-surgeons who had successively resided at Bicêtre during the years 1861–1862, and compared their dimensions with those of the heads of twenty-four porters attached to the various wards of the same hospital. This comparison resulted in the confirmation of the generally received opinion, that the anterior lobes are the seat of the highest order of intellectual faculties.Google Scholar

† Dr. Maudsley denies the existence of a speech faculty, and says, “There is no more a special faculty of speech in the mind than there is a special faculty of dancing, or of writing, or of gesticulating.” Google Scholar

‡ Vide Journal of Mental Science, for April, 1869, p. 117.Google Scholar

∗ I am aware that the above conclusions are disputed by other physiologists (Dieulafoy, M.M. and Krishaber, ). Ferraud's, M. experiments, however, seem to me to be conclusive; having opened the trachea in rabbits, he introduced a tube, and then divided the trachea above; a small cupping glass, containing a sponge imbibed with chloroform, was then placed over the nose of the rabbit; in three minutes the anæsthetic condition was produced, and maintained as long as the olfactory apparatus was submitted to the action of chloroform. When the same animal was chloroformed by means of the tracheal tube and the respiratory apparatus, anæsthesia was produced a little sooner (i.e., by 15 seconds) than when the anæsthetic was administered by the olfactory apparatus. Gazette des Hôpitaux, May 29, 1869.Google Scholar

† On the state of the Small Arteries and Capillaries in Mental Disease. Journ. Ment. Science, Jan., 1869.Google Scholar

∗ Lectures on the Germinal or Living Matter of Living Beings. Medical Times, July 10, 1869.Google Scholar

∗ In the elaborate paper by Br. Sankey, to which I have already referred, is the following passage corroborative of these views:—“Each act of cerebration (which results from an action of the blood and the cerebral tissue) requires that the blood be unimpaired in quality, and of a just quantity; blood impaired as to quality produces imperfect cerebration as proved by the injection of poisons into the blood, by the action of certain drugs which are known to enter the circulation.” Google Scholar

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