treatise on loss of memory and of speech, illustrating it by a series of well recorded cases, to some of which I propose very briefly to refer.* A ploughman, Wt., aged 40, of short stature, fell through the trap door of a garret upon the left side of the head. Much blood immediately flowed from the left ear and mouth, the bleeding from the ear continuing for two days. For four weeks he lay stunned and without power of recollection; he heard nothing, his speech was unintelligible, and his eyes were closed. When his consciousness was fully recovered, it was noticed that both eyes were turned towards the nose, (there was double convergent strabismus), the pupils were somewhat dilated and sluggish, there was intolerance of light and diplopia; his memory was observed to have suffered in a peculiar manner-the memory of proper names and of substantives was abolished, whilst that of things and places remained unimpaired; and he also had retained the power of correctly speaking and using verbs. He knew what he wished and ought to say, but could not connect the letters of substantives one with another. He knew exactly the place, the way, the streets, and their names, although he was quite unable to give utterance to these names. The same defect was noticed in reference to the furniture, and in fact to every other object. He was shown a penknife, a key, a looking glass, and he described their use by a periphrase. He said of the scissors which were shown him—it is what we cut with. On pointing to the windows he said, it is what we see throughwhat admits light. * Einige Bemerkungen über Störungen des Gedächtniss und der Sprache, Allgemeine Zeitschrift für Psychiatrie, 1849, S. 657. A man of large stature, strong constitution, and ruddy complexion, with knowing, lively, expressive eyes, for upwards of ten years had never spoken a single word, not even a yes or no, when alone or in company. He heard well, had a good memory, and a proper supply of ideas. He wrote a particularly firm and correct hand, and was never tired of putting his ideas and foolish fancies on paper. From these written effusions it was seen that his principal delusion was that he considered himself a great lord and potentate, who sent his decrees and decisions forth to the world. He was always accusing others, but in the most dignified language; and he commanded and gave his instructions after the manner of one learned in the law of the highest courts of appeal. It was evident that he had intelligence, but a perverted one; he heard and understood, as his written answers and other behaviour clearly showed. He was docile, he waited on the other patients like a brave nurse, and willingly employed himself with ordinary handiwork. During the many years that this man remained under observation, no means were left untried to ascertain whether he could be made to speak; but no fraud, no surprise, no sudden or sharp pain, no electric shock, no hot iron, no entreaty, no threat had ever succeeded in extracting from him even the slightest yes or no. Dr. Bergmann, in commenting upon this singular case, and in endeavouring to reach the explanation of the physiological and pathological enigma involved in it, suggests two hypotheses: That there may have been a fixed idea, a fixed will, a caprice, an obstinate strong purpose, his physiognomy seeming to say—I remain still firm and true to myself, I will carry out my purpose, I will triumph, and I will not yield. Then on the other hand, if one considers that he was good-hearted and well-disposed, obliging and friendly, and that he was scarcely ever angry, notwithstanding all the opposition to his wishes, it would seem more probable that there was a real organic inner momentum (inneres organisches Moment), some hidden impediment which produced loss of speech. The only remaining case from this author to which I shall allude is that of Anna W., æt. 30, who up to the age of twenty was sound in mind and body, when a nervous fever laid the foundation of mental disturbance and chronic headache. After a time weakness of memory was noticed, and she became indifferent, unfeeling, and unsympathising. There was this peculiarity about the memory-that it was particularly weak and almost extinct in reference to subjects of recent date, whilst she could well remember the events of the earlier period of her illness. For upwards of two years she had never spoken a word, however much one roused her, although her manner gave unmistakable evidence that she could hear and understand what she heard. She had thoughts, conceptions, and ideas; there must then, says Dr. Bergmann, be an organic defect which rendered her unable to give vent to her thoughts by means of words or even by a sound. I shall again have occasion to refer to Dr. Bergmann's highly philosophical treatise in another part of this essay. Dr. Hasbach, of Geldern, has recorded the following case of left hemiplegia with aphasia :-A merchant, aged thirty-six, with a robust, thick-set body, who, from speculating in the funds, became in a short time very rich, was suddenly seized in the night after a hearty meal with apoplexy, resulting in complete paralysis of the left arm and leg, and loss of speech. After a month's treatment, the paralysis of the leg had so far subsided that he could walk slowly with the aid of a stick, the upper extremity remaining, however, entirely paralysed and deprived of sensation. With the exception of one single phrase, he did not recover the power of speech, the only words he could articulate being, "gerechter Gott," which he would repeat a hundred times each day. There was also this remarkable peculiarity, that although he could pronounce clearly and distinctly so difficult a phrase as gerechter Gott, he was quite unable to articulate separately the letters of which this expression was composed.* Dr. W. Nasse, of Bonn, has written a valuable essay on defects of speech, in which he mentions the case of a man thirty years of age, who, after repeated attacks of apoplexy, was paralysed on one side of the body, retaining possession of his mental faculties. The movements of his tongue were unfettered, and he could make himself understood; in the middle of his sentences, however, he often applied wrong words, but immediately recognised his mistake, expressed concern for it, and would endeavour to extricate himself from his difficulty by gesture and periphrase. If the required word were named before him, he would repeat it with glib tongue, and could also write it down. After repeated attacks of cerebral congestion, the power of speech progressively diminished, and he gradually fell into a state of imbecility. Allgemeine Zeitschrift für Psychiatrie, 1852, S. 262. Dr. Nasse, in his general remarks, calls attention to the fact that most frequently proper names and substantives, words which are first learnt in childhood, and which are in more general use, seem to disappear, whilst verbs and adjectives, which are acquired later, remain preserved. He also thinks the loss of the memory of words bears no relation to the condition of the muscular power Von Benedikt and Braunwart have an excellent and exhaustive paper on lesions of the faculty of speech, from which I shall only quote the following case of aphasia from lead poisoning, as reported by Heymann. † Jacob Astheiner, journeyman plasterer, aged sixteen, had suffered for many years from time to time, with lasting headache. Eventually, in the otherwise taciturn patient, were observed great vivacity and wantonness, and the ordinary symptoms of plumbism. A few days afterwards he ceased to answer any questions, and was unable to utter a syllable; there was also agraphia. A fortnight later his speech partially returned, and he spoke a few words very indistinctly, and would for many hours together cry out Va-ater, Mau-auter, and also Hu-unger with joyful, excited voice. This patient gradually but entirely recovered. It will be observed that in some of the preceding cases, the subjects of them were lunatics or persons of weak mind; in my opinion, they are none the less valuable on that account; in fact, Broca's first two cases, the publication of which has given rise to so * Allgemeine Zeitschrift für Psychiatrie, 1853, S. 525. |
