went into his room to inquire after his health, he was surprised to find Mr. R➖➖ could not answer his questions. Dr. Jackson having been summoned, found the patient in full possession of his senses, but incapable of uttering a word; the tongue was not paralysed, but could be moved in every direction; all questions were perfectly comprehended and answered by signs, and it could be plainly seen by the smile on the countenance, after many ineffectual attempts to express his ideas, that he was himself surprised, and somewhat amused at his peculiar situation. The face was flushed, the pulse full and somewhat slow, and to the inquiries if he suffered pain in the head, he pointed to his forehead as its seat. When furnished with pen and paper, he attempted to convey his meaning, but he could not recall words, and only wrote an unintelligible phrase, "Didoes doe the doe." Forty ounces of blood were drawn from the arm, and before the operation was completed speech was restored, though a difficulty continued as to the names of things, which could not be recalled. The loss of speech appearing to recur in fifteen minutes, ten ounces more blood were abstracted, and sinapisms supplied to the arms and thighs alternately. These means were speedily effectual, and no further return of the affection took place.

Dr. Jackson, in analysing this case, calls attention to the following facts. Firstly, sudden suppression of the cutaneous transpiration, succeeded by cerebral irritation and determination of blood to the brain: secondly, frontal pain immediately over the eye: thirdly, perfect integrity of the sensations and voluntary movements: fourthly, the general operations of the intellect undisturbed; ideas formed, combined, and compared; those

of events, of time, recalled without difficulty: fifthly, loss of language or of the faculty of conveying ideas by words though not by signs; this defect not being confined to spoken language, but also extending to written language.*

Dr. Hun, of Albany, mentions the case of a blacksmith, æt. 35, who, before the present attack, could read and write with facility, but who had been labouring for several years under a disease of the heart. After a long walk in the sun, he was seized in the evening with symptoms of cerebral congestion, remaining in a state of stupor for several days. After a few days he began to recover from this condition, and understood what was said, but it was observed that he had great difficulty in expressing himself in words, and for the most part could only make his wants known by signs. There was no paralysis of the tongue, which he could move in all directions. He knew the meaning of words spoken before him, but could not recall those needed to express himself, nor could he repeat words when he heard them pronounced; he was conscious of the difficulty under which he was labouring, and seemed surprised and distressed at it. If Dr. Hun pronounced the word he needed, he seemed pleased, and would say, "Yes, that is it," but was unable to repeat the words after him. After fruitless attempts to repeat a word, Dr. Hun wrote it for him; and then he would begin to spell it letter by letter, and after a few trials, was able to pronounce it; if the writing were now taken from him, he could no longer pronounce the word; but after long study of the written word, and frequent repetition, he

* American Journal of Medical Sciences, February, 1829, p. 272.

would learn it so as to retain it and afterwards use it. He kept a slate, on which the words he required most were written, and to this he referred when he wished to express himself. He gradually learned these words and extended his vocabulary, so that after a time, he was able to dispense with his slate. He could read tolerably well from a printed book, but hesitated about some words; when he was unable to pronounce a word, he was also unable to write it until he had seen it written; and then he could learn to write as he learned to pronounce, by repeated trials. At the end of six months, by continually learning new words, he could make himself understood pretty well, often, however, employing circumlocution, when he could not recall the proper word, somewhat as if he were speaking a foreign language, imperfectly learned.

Dr. Hun infers, from what precedes, that there is a portion of the brain connected with language or the memory of words, as distinct from the memory of things and events; and that there is another portion on which depends the co-ordination of the movements of articulation. It will be observed that in the above case, the impression made on the acoustic nerve was not sufficient for rendering the articulation of the word possible, but that it was necessary that an impression should be made upon the optic nerve. Dr. Hun asks whether this can be explained by the supposition of a more intimate connection between vision and articulation, or by the fact that the impression on the acoustic nerve is transient, whilst that on the optic is more permanent.*

* American Journal of Insanity, April, 1851.

One of the most important American contributions to the literature of aphasia is that of Dr. Wilbur, the Superintendent of the State Asylum for Idiots, at Syracuse, N. Y., who has written an extremely interesting pamphlet, in which he treats the aphasic question, as illustrated by his own experience amongst idiots.

Of the 443 idiots he has had under his care, 121 were entirely mute-could not or did not utter a single word; 64 could say only a word or two; in 163 there was imperfect speech; and 95 are described in the register as able to speak. In these last cases, he adds, the ability to speak was commensurate, in some degree, with the intelligence; but, in a large proportion of them, there was great backwardness in learning to speak.

A large proportion, perhaps seventy-five per cent, of Dr. Wilbur's cases were congenital; the remainder had their faculties impaired by disease in infancy or early childhood. In these latter, when there was loss of speech, it occurred in some instances gradually, but more commonly instantly. He adds that intelligence, and speech or expression, have certainly not always gone with an equal step.

Dr. Wilbur gives the clinical history of his patients, with special reference to their loquelar defect; it is, however, much to be regretted that in no instance is the case completed by a post-mortem examination. I have selected the following case from Dr. Wilbur's collection, as tending to illustrate how much may be done towards partially developing speech in the idiot:

A boy, eight years old, good looking and well formed, came under observation, idiocy having supervened in infancy. He

looked intelligent, was very gentle and obedient; he understood any simple language addressed to him, or spoken in his hearing; he could repeat the sentences he heard, or the question spoken, but could originate nothing in the form of speech, under any circumstances. The control over his vocal

organs was complete; he spoke quite distinctly, and with appropriate emphasis. He soon began to learn rapidly the exercises given to him, but the power or disposition to originate speech, even within the range of his wants or his affections was wanting. The failure in the power of speech seemed to be in the absence of the proper volition. In this case, the defect was overcome at last, through reading exercises, and eventually the boy could speak spontaneously.*

It may be said that imperfection of speech in the idiot is so intimately connected with a general want of intelligence, that it bears but little analogy to loss of speech as occurring in individuals of full intellectual capacity. Whilst, to some extent admitting this, when I consider Dr. Wilbur's great success in developing the power of expression in the idiot, I cannot but think that if other physicians with similar opportunities to his, would follow his example and place on record their own experience, a lasting benefit would be rendered to the cause of psychological science, and the solution of the particular question we are now discussing would be materially aided.

Dr. Austin Flint, in giving an account of six cases which had fallen under his observation, expresses his strong dissent from the doctrine of the localisation of the faculty of speech in the left hemisphere, and he thinks that anatomical researches may show why lesion of speech is a more constant accompaniment of dextral than of sinistral paralysis.

* On Aphasia, p. 23.