When we have reason to infer that the brain lesion is of an irritative character-as perhaps indicated by early rigidity of the paralysed muscles, and by their extreme sensibility to the galvanic stimulus-we are justified in expecting some benefit from the abstraction of blood; where an opposite condition exists, bleeding will probably be worse than useless. When loss of speech occurs in hysterical and highly excitable persons, or is an accompaniment of the choreic or epileptic condition and may depend on a spasmodic state of the cerebral arteries, diffusive stimulants and antispasmodics will be found of service. Crichton mentions a case in which large doses of Valerian were effectual, and Dr. Hutchison, of the United States, has recorded a case where hysterical loss of speech was cured by Etherisation.* There are certain cases in which the aphasia seems to depend on a kind of cerebral catalepsy, and where very powerful stimulants, such as electricity, prove of great value. I have elsewhere stated that in one of my own cases, that of Sutherland, electricity had a decidedly baneful effect; and in this affection, as well as in motor paralysis, this powerful remedial agent must be used with the greatest caution. In reference to its use, we cannot do better than observe the distinction laid down by Dr. Todd—that electricity is injurious when there is an early tendency to muscular rigidity, showing an exalted polarity of nervous tissue, and probably an irritating lesion of the brain; thus, when the aphasia is an accompaniment of muscular paralysis, the result of electricity on the limbs affected may serve to guide * Medical Times, July 29th, 1865. us in our diagnosis, by showing whether the lesion is irritative or depressing.* Strong mental emotion is often salutary in such cases; we are all familiar with the story in Herodotus of the son of Croesus, who had never been known to speak, but who, at the siege of Sardis, being overcome with astonishment and terror at seeing the king-his father -in danger of being killed by a Persian soldier, exclaimed aloud—Ανθρωπε μὴ κτέινε Κροισον—Oh, man, do not kill Croesus! This was the first time he had ever articulated, but he retained the faculty of speech from this event as long as he lived.† Herodotus is universally admitted to be a trustworthy historian, but if it be thought far-fetched to illustrate a subject by allusion to a work written 500 years before the Christian era, I may add that such cases have been met with by other observers. My friend, Mr. Dunn, has recorded a similar one, and a few months ago, I myself was invited * In the "Lancet," for January 23rd, 1869, Dr. Marcet has mentioned a most striking instance of the benefit of electricity in a case of hemiplegia with aphasia, where, after recovery from the paralysis, the loss of speech continued. Dr. Marcet, having determined to try galvanism with Smee's battery, one of the electrodes was applied, by means of Mackenzie's galvaniser, to the tongue, and the other to the back of the neck, in contact with the spine. Speech began to return from the very first application of the galvanism, and continued steadily to improve each time it was used. + Herod. Hist. I., 85. Aulus Gellius, after repeating the above story from Herodotus, relates a similar fact in the following terms :-Sed et quispiam Samius athleta, nomen illi fuit Alyλns, quum antea non loquens fuisset, ob similem dicitur causam loqui cœpisse. Nam quum in sacro certamine sortitio inter ipsos et adversarios non bona fide fieret, et sortem nominis falsam subjici animadvertisset, repente in eum, qui id faciebat, sese videre, quid faceret, magnum inclamavit. Atque is oris vinculo solutus, per omne inde vitæ tempus, non turbidè neque adhæsè locutus est. Noctes Attica. lib. V. cap. ix. by Mr. Allen, of Norwich, to see with him a man, aged 37, who had been in his usual health up to the day preceding my visit, when, during a meal, his wife noticed that all his limbs were shaking, and from this time he became speechless. The suspension of speech was unaccompanied by any symptom of paralysis, and the loss of the faculty of articulate language continued for six days, when being asleep on his couch, he suddenly started up, and was heard to say three times, "A man in the river!" From this moment speech was restored, and when I saw him an hour afterwards, he told me that he had dreamed that a man was falling into the river; the mental shock produced by this dream was salutary, for it resuscitated the previously dormant faculty of articulate language. In our efforts at the restoration of speech, we must not lose sight of the fact that as muscles from want of use lose their contractile power, and become atrophied, so it is possible that the convolution or portion of brain presiding over articulate language-assuming pro hâc vice that there is such a localised centre-may, from long disuse and actual cessation of function, undergo a change of some kind, by which the patient may be somewhat in the same condition as that of a child who has not yet learned to speak; thus, one of the most interesting features in the treatment of certain cases of aphasia is the education of the organs of the speech, as it were, de novo. Several instances has been recorded confirmatory of this view. M. Piorry relates the history of a merchant who had to re-learn his ab c.* Dr. Banks' case of the * Gazette des Hôpitaux, May 27, 1865. gentleman re-learning Greek and Latin is a further illustration, as also the remarkable observation of Dr. Hun, which I have recorded when treating of the American contributions to this subject.* Perhaps the most satisfactory result of efforts to re-learn to speak is that recorded by Dr. Osborne, in connexion with his remarkable case to which I have already alluded under the head of Varieties. Dr. Osborne says:-“ Having explained to the patient my view of the peculiar nature of his case, and having produced a complete conviction in his mind that the defect lay in his having lost, not the power, but the art, of using the vocal organs, I advised him to commence learning to speak like a child, repeating first the letters of the alphabet, and subsequently words after another person. The result has been most satisfactory, and affords the highest encouragement to those who may labour under this peculiar kind of deprivation; there being now very little doubt, if his health is spared, and his perseverance continues, that he will obtain a perfect recovery of speech."† However hypothetical, therefore, the re-education of the nervous centres may, at first sight, appear, there exists sufficient evidence to induce us, in all cases where cerebral loss of speech is unattended by any marked lesion of the intelligence, to endeavour gradually to rouse into action the complex apparatus, the concurrence of which is necessary for the re-establishment of man's noblest prerogative—the faculty of articulate language. * Vide Journal of Mental Science, April, 1868. + Dublin Journal of Medical Science, Nov., 1833, p. 169. PART VI. 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. We are now, therefore, in a position to criticise the value of the different opinions which have been propounded as to the precise point of the cerebro-spinal centre which is affected in aphasia, or in other words, to consider whether there be a cerebral seat of speech at all, and if so, where it is located; and I propose in this concluding part to summarise, and carefully to weigh the evidence furnished by the numerous cases recorded in the previous pages. Leaving for the present the question of the existence or non-existence of a speech centre, and assuming pro hâc vice that there is one, I |