volutions, he considers the aphasia was incontestably due to disease of that portion of the nervous centres. Whilst admitting that two cases are insufficient to resolve one of the most obscure and disputed questions in cerebral pathology, M. Broca considers himself justified in asserting that the integrity of the third frontal convolution (and perhaps of the second) appears indispensable to the exercise of the faculty of articulate language.* A later writer of the French School, Dr. J. Falret, has collected from various authors no less than sixtytwo cases, in the arrangement of which he adopts the following classification: 1st. All those cases in which the patients, whilst retaining intelligence and integrity of the organs of phonation, can only remember or articulate spontaneously certain words or classes of words, or even certain syllables or letters, but who can repeat and write any word that may be suggested to them by others. 2nd. Those in which the patients are only able to pronounce spontaneously certain words, syllables, or phrases always the same, not being however able to repeat other words dictated to them, although they retain the power of writing them; or if the power of repeating words thus dictated be retained, that of writing them is abolished. 3rd. Those more rare cases in which the patients can only pronounce certain words always the same, which, aided by gesture, enable them to express their thoughts, the power of reading, writing, and repeating words dictated, being abolished. Dr. Falret admits that this classification is artificial, and probably does not embrace all the varieties * 'Sur le Siége de la Faculté du Langage Articulé,' p. 39. met with in practice. After paying a just tribute to recent workers in this field of observation, he concludes his very elaborate essay with remarking:-"That the question of perverted speech and of loss of the memory of words in cerebral affections is not yet matured; that it is more complex and more extensive than at first sight appears; that it borders upon the most obscure and the most disputed points of cerebral pathology and of the physiology of language; and that fresh observations of a detailed character are indispensably necessary, and that all generalization and all absolute conclusions are, for the present, premature."* Professor Trousseau has made this subject a prominent feature in his clinical lectures, where he details several most interesting cases in which, when hemiplegia existed, it was with one exception always on the right side.+ During several months of the session of 1865, the French Academy of Medicine became the arena for discussion upon this most interesting subject, in which many of the leading physicians and surgeons took a part. At one of these meetings M. Trousseau gave the result of his statistical researches, and stated that in 134 observations collected by himself, 124 were confirmatory of M. Dax's proposition of localizing the faculty of speech in the left hemisphere, and 10 were contrary. With regard to M. Broca's theory of attributing aphasia to a lesion of the third frontal convolution, he found that 14 cases were in favour of it, and 18 opposed to it; amongst the latter, he mentioned the case of a woman treated at La Salpêtrière by M. * Des Troubles du Langage, p. 53. + ‘Clinique Médicale,' tom. ii, p. 571. Charcot for right hemiplegia with aphasia, and where after death there was found a lesion of the left insula, and also of the third frontal convolution of the right side. M. Trousseau also cited a case observed by M. Peter, the subject of which was a woman who had left hemiplegia, and who could only say, "Oui, parbleu !" who died from the effects of senile gangrene, and at whose autopsy a lesion was found of the third frontal convolution of the right side, also of the insula and of the posterior part of the corpus striatum, there being also embolism of the middle cerebral artery. Here, says M. Trousseau, are two cases of aphasia, with a lesion on the right side. At another of these discussions M. Velpeau alluded to the fact of M. Bouillaud having offered many years since a prize of 500 francs for any well authenticated case in which the two anterior lobes were destroyed, or more or less seriously injured, without speech being affected, saying that he (M. Velpeau) should claim the prize on the faith of the following case, with specimen, which he presented to the Academy twenty-two years ago. In the month of March, 1843, a wigmaker, sixty years of age, came under M. Velpeau's care for a disease of the urinary passages. With the exception of his prostatic disease, he seemed to be in excellent health, was very lively, cheerful, full of repartee, and evidently in possession of all his faculties; one remarkable symptom in his case being his intolerable loquacity. A greater chatterer never existed; and on more than one occasion complaints were made by the other patients of their talkative neighbour, who allowed them rest neither night nor day. A few days after admission this man died suddenly, and a careful autopsy was made, with the following results:-Hypertrophy of the prostate, with disease of the bladder. On opening the cranium a scirrhous tumour was found, which had taken the place of the two anterior lobes! Here then was a man who up to the time of his death presented no symptom whatever of cerebral disease, and who, far from having any lesion of the faculty of speech, was unusually loquacious, and who for a long period prior to his decease must have had a most grave disease of the brain, which had destroyed a great part of the anterior lobes. During the protracted debates at the Academy of Medicine, the pathological and psychological aspects of the question were reviewed with great force and eloquence, but the discussion closed without this learned body having arrived at any definite decision in reference to the localization of the faculty of speech. Several very interesting observations have been recorded in the French press, most of which are more or less corroborative of Broca's views, or at least of the association of loss of speech with lesion of the left hemisphere. In the 'Gazette des Hôpitaux' for July 1st, 1865, Dr. Lesur mentions a remarkable case of a child, who, in consequence of a fracture of the frontal bone caused by a kick from a horse, was trepanned about one inch and a quarter above the left orbit. The child recovered, but during the progress of the treatment it was observed that pressure on the brain at the exposed part suspended the power of speech, which returned as soon as the pressure was removed. Another case of traumatic aphasia has recently occurred in the practice of Dr. Castagnon, the subject of it being a young girl, aged 20, who was shot in the head, the accident resulting in a comminuted fracture of the antero-superior portion of the left parietal; although there was no depression of bone, several spiculæ were removed, and there was subsequently hernia cerebri and sphacelus of the protruded portion, which was removed by ligature. There was a comatose condition for six days, dextral paralysis and complete loss of speech for a month, at the end of which time she could speak, her vocabulary, however, being limited to four phrases, "Mon Dieu! Jesus! mon père, ma mère.” At the expiration of a year the paralysis had subsided, and the patient resumed her occupation, but although the intelligence was as perfect as before the accident, the young girl spoke but very little, and with great difficulty.* An interesting case was observed a few months since at the Hospital St. Antoine by M. Jaccoud, the subject being a man aged 44, suffering from Bright's disease, who, without any premonitory symptom, suddenly became aphasic, there being no other paralytic symptom except a limited facial paralysis. The aphasia was of short duration, and at the end of five weeks he spoke nearly as well as before, but soon sank from disease of the kidneys. At the post-mortem there was observed fatty degeneration of both kidneys; insufficiency of the mitral valve, which was covered with small vegetations; the arteries of the circle of Willis were healthy, and there was no disease of the grey matter of the convolutions, but there was a limited and well-defined softening * 'Gazette des Hôpitaux,' Oct. 12, 1867. |