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it had been thought healthy because it had been looked for where it did not exist !*
The last case to which I shall allude under this head is recorded by M. Langaudin of Nice, the subject of it being a soldier, who discharged the contents of a pistol through the mouth, the ball traversing the arch of the palate in the median line; the patient lived two months, and speech was unaffected, although after death it was found that the anterior lobe of the left hemisphere was entirely destroyed by suppuration.
I conclude the history of the French contributions to the literature of aphasia by a brief allusion to Dr. Ladame’s essay on lesions of speech in connection with tumours of the brain. From his researches it would seem that derangement of speech is not common in cerebral tumours, he having observed it only 44 times in 332 observations. According to Dr. Ladame’s valuable statistics, tumours of the corpus striatum and of the pons varolii are more frequently attended by loss of speech than those occurring in any other part of the encephalon. He found that tumours in the middle lobes were more frequently accompanied by lesion of speech than those occupying the anterior lobes, in the proportion of five to four. These curious results have led Dr. Ladame to dissent from the doctrine which would place the seat of articulate language in the anterior lobes.
. Gazette des Hôpitaux,' Sept. 28, 1865.
+ Ibid., April 29, 1865.
From the brief summary I have given of the labours of the pathologists of the French school, it will be observed that the evidence deducible therefrom is of such a conflicting character, as to leave quite unsettled the complex question of the localisation of the faculty of speech. The history of the continental contributions to the literature of aphasia would, however, be very incomplete, without a brief glance at the researches of the German and Dutch physiologists.
Schroeder van der Kolk,* in his chapter on the accessory ganglia in the medulla oblongata, endeavours to establish a close physiological and pathological connection between the function of articulation and speech and the corpora olivaria. Besides citing numerous cases in illustration of his hypothesis, he gives an a priori reason for his theory in the fact that the corpora olivaria occur only in mammalia—that on comparing these organs as occurring among mammalia themselves, it is to be observed that they nowhere exist on so extensive a scale, and are so fully developed, or present so strongly plaited a corpus ciliare, as in man; that in the higher mammalia, as the apes, they are most like those in man, and that in man they exceed in circumference by two or three times those of the chimpanzee. To Van der Kolk, these circumstances are suggestive of the idea that in man the corpora olivaria have a much more important function to discharge than in animals; and as these bodies are connected by special fasciculi with the nuclei of the hypoglossus, he looks upon them as auxiliary ganglia of that nerve, and as such, joined to it for the production of special combinations of movement. He also suspects that the very delicate combinations of motion in the human tongue in articulation and speech, may afford an explanation of the much greater size of the olivary bodies, and of their more intimate connection with the nuclei of the hypoglossus. In support of these views, Van der Kolk cites several cases of impairment of the faculty of speech, in all of which there was found after death lesion or degeneration of the olivary bodies. Of these observations the limits of this essay will only permit me briefly to allude to one which seems to me to be particularly pertinent to the subject now under consideration :
* On the Minute Structure and Functions of the Spinal Cord and Medulla Oblongata. Translated by Dr. W. D. Moore, p. 140.
G. van A., aged 22, had been dumb from birth, but not deaf. She had always enjoyed good health, and although idiotic, usually understood all that was said to her; but had never been able to form an articulate sound, and only now and then uttered a squeak. The patient having died from the effects of diarrhoea, the following appearances were observed at the autopsy. On removing the hard, but thin and small skull, the cerebrum appeared small and ill-developed; the convolutions, especially on the anterior lobes, were slight and not numerous; in consequence of the diminished arching of the anterior lobes, the so-called convolutions of the third rank of Foville were very small, and scarcely shown on the inner longitudinal surface of the hemispheres; the convolutions on the posterior lobes were also but little developed. On the anterior lobes, beneath the os frontis, was seen a spot of the size of the palm of a small hand, and bloody exudation under the arachnoid, in which situation the pia mater was adherent to the cortical substance, which was in many parts softened. On section the grey and white substances were here and there thickly studded with red sanguineous points; the thalami optici presented a strikingly yellow colour; the pons Varolii was smaller and narrower than usual, and the corpora olivaria were unusually minute and slightly developed, being less than one third of the normal size.
Van der Kolk, in commenting on this case remarks : that as in this instance there was complete inability to articulate, and consequent absence of speech, without deafness and without proper paralysis of the tongue, which the patient could move, coinciding with an extremely defective development of the corpora olivaria; therefore the influence of these bodies on the complicated movements of the tongue in speech seemed scarcely to admit of doubt!
It will be observed that in laying great stress on the fact of the atrophy of the olivary bodies, the learned Utrecht Professor quite loses sight of the deductions to
drawn from the extremely imperfect development of the frontal convolutions, and also from the positive diseased condition of the anterior lobes; and it seems to me that both Bouillaud and Broca would have a word to say here in favour of their respective theories.
In further support of his views Van der Kolk quotes two cases, observed by Cruveilhier, in one of which the right corpus olivare had undergone grey degeneration, and in the other both these bodies were found as hard as cartilage.
Romberg mentions the case of a sailor, who, on being struck on the left side of the head by a loose rope, at once fell into a state of insensibility. After a quarter of an hour he recovered consciousness, but was found to have lost the use of the right half of the body, and to have become speechless. Three weeks afterwards the mobility of the extremities had been restored, and the tongue could be moved in every direction without difficulty, but the faculty of speech was arrested; and although perfectly conscious, it was only with the greatest effort that he was able to utter a few inarticulate sounds. Some blood was taken locally on several occasions by leeches applied behind the left ear, a combination of sulphate of magnesia and tartar emetic being administered at the same time; and in three weeks from the commencement of this treatment his speech returned, and he was completely restored. He also mentions an interesting case of impairment of the speech, with partial paralysis of the left side, which after death was seen to depend upon a large tumour, seated in the right half of the pons Varolii, and extending posteriorly under the right olivary body.t
Dr. Bergmann, of Hildesheim, has written a masterly
* On the Nervous Diseases of Man.
Translated by Dr. Sieveking,
+ Ibid, p. 407.