When all other forms of language are either suspended or perverted, there may still remain one, which is the same in all countries and among all people-the language of physiognomy: the aphasic may still evince pleasurable sensations by a smile, give evidence of fear by pallor of the countenance, and of shame by the blush on the forehead, "Sæpe tacens vocem, verbaque vultus habet."* 9.-There is a variety of aphasia characterized by this peculiarity-that although the subjects of the affection can articulate nothing else whatever, they can give vent to an oath, and thus, in the heat of passion or excitement, words or phrases not always correct as regards taste or ethics are ejaculated, and which the patient is wholly unable to reproduce when the stimulus of emotion is wanting. I have already incidentally alluded to a case of Dr. Hughlings Jackson, in which the patient had recovered the power to swear, although continuing aphasic. Dr. Gairdner mentions the case of a patient in the Edinburgh Royal Infirmary whose sole means of communication with others was by signs. After a time, Dr. Gairdner noticed that the other patients believed he was shamming, and on inquiry, they gave as a reason for their opinion, that he could swear. The man shortly afterwards died suddenly, when his brain was found to be the seat of a large number of minute deposits of cancer.† * This language of physiognomy has not been sufficiently considered by writers on the localisation of the cerebral faculties. This subject is fully developed by M. Albert Lemoine in his philosophical treatise entitled La Physionomie et la Parole, Paris, 1865. "On the Function of Articulate Speech," p. 14. Dr. Hughlings Jackson hints that these oaths and interjectional expressions as observed in aphasic patients, may be due to reflex action, and he goes on to say: "It is quite obvious that they are not voluntary, as the patients cannot repeat the phrases. The will cannot act, but somehow an emotion, e.g., anger, gets the words passed through the convolution of language. Just as a paralysed foot will jump up when the sole is tickled, so these words start out when the mind is excited. Such ejaculations seem to have become easy of elaboration by long habit, and require but slight stimulus for perfect execution."* 10.-Aphasia spasmodica. Spasmodic mutism occurs in connexion with hysteria and in hypochondriasis, and may be of a more or less persistent character. Dr. Bright has recorded two cases in which the inability to speak coincided with hysterical trismus.† A similar case was lately under my observation, the subject of it being a girl eleven years of age, who, after exposure to cold and damp, was brought to the hospital, because her mother found she was unable to speak. On examining her, it was found that there was a forcible closure of the lower jaw, but the moment the mouth was pressed open, she could speak as before. Dr. Todd, in speaking of an analogous case, uses the word catalepsy in his description of it. Dr. Willis mentions a curious case of this kind, which he calls "paralysis spuria." His description is so quaint that I am tempted to transcribe it: * London Hospital Reports, Vol. i., P. 454. + Bright's Reports of Medical Cases, Vol. ij., part 2., p.p. 459 and I "Curo jam nunc foeminam prudentem et probam, quæ per plures annos hujusmodi spuriæ paralysi non tantum in membris sed etiam in linguâ obnoxia fuit; hæc per tempus quoddam libere et expedite satis loquitur, post sermones tamen longos, aut illos festinanter et laboriose prolatos, illico sicut piscis obmutescens, amplius ne gry quidem proloqui potest, porro nec nisi post horam unam, aut alteram vocis usuram ullam recuperat. Having thus briefly alluded to the principal forms in which loss or lesion of the Faculty of Articulate Language is met with in practice, I propose, in the next place, to consider Aphasia in reference to its Cause, Diagnosis, Prognosis, and Treatment. # Op. T. Willis, M.D., De Paralysi, De animâ Brutorum, cap. ix., p. 149. PART V. HAVING noticed the different forms in which loss or lesion of the Faculty of Articulate Language is met with by the clinical observer, I now propose to consider the various causes which give rise to this morbid symptom. The study of the etiology of any disease affords one of the best clues to a clear knowledge of its nature and probable course; and as the pathology of aphasia is involved in so much obscurity, it seems especially desirable carefully to review the various circumstances, physical and moral, under which defects in the power of speech have become developed. CAUSES. A variety of morbid conditions may produce lesion of the faculty of speech. 1.-It may be congenital as in the deaf and dumb, and it is one of the frequent symptoms of idiocy; the case of G. van A. which I have quoted from Van der Kolk, is a good illustration of this latter condition. The subject of the loquelar defects in idiots is treated in a masterly manner by Dr. Wilbur, Superintendent of the New York State Asylum for Idiots, to whose interesting treatise I would refer for more complete information on this point.* M. de Font-Réaulx has published the history of a deaf mute, who died at Bicêtre at the age of 60, and at whose autopsy, there was found a remarkable atrophy of the island of Reil on both sides, especially on the left; the brain itself, however, was very large, with its convolutions particularly well developed, the entire encephalon weighing 1,620 grammes (57 ounces).† This observation is of extreme interest as contrasting with the microcephalic brains to which I shall allude hereafter. The study of the muteness of the deaf is a subject well worthy of the careful investigation of those members of our profession who have the medical charge of institutions for the deaf and dumb, for it is now recognised that this infirmity is partly remediable; in fact, a noted French writer upon this subject says "il est possible de donner la parole à la plus grande partie des sourds-muets, car c'est le plus petit nombre, c'est l'exception qui présente des vices primordiaux ou acquis de l'appareil vocal." In reference to this subject Dr. Gairdner has observed that the aphasic, supposing the disease congenital, could not possibly be educated, but must remain almost an idiot-the mind of an infant enclosed in the shell of a man; he further remarks that in certain forms of cretinism, or of con * On Aphasia, New York, 1867. + Localisation de la faculté spéciale du Langage Articulé, p. 99. La Surdi-Mutité, par Dr. Blanchet, Chirurgien de l'Institut National des Sourds-Muets, tom. ii., p. 12. |