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One of the latest communications that have come under my notice is a paper by Dr. Seguin, in which he gives a report of fifty cases of aphasia that have been observed at the New York Hospital. This essay contains much interesting matter, but the description of the cases is so meagre, as to render the collection conparatively useless for statistical purposes.*
Having in the preceding pages endeavoured to give a brief sketch of the labours of the principal authors in various parts of the world who have written on the subject of loss or impairment of the faculty of articulate language, I shall, in the next number, give the results of my own personal experience, as embodied in a series of important cases which have fallen under my own immediate observation.
* American Quarterly Journal of Psychological Medicine, Jan., 1868. PART III.
Having in the preceding pages endeavoured critically to review the question of the localisation of the faculty of speech, as illustrated by the labours of the French, Dutch, and German pathologists, as well as by those of the different branches of the Anglo-Saxon race, I now proceed to place on record a certain number of cases which have been observed by myself, and in several of which the clinical history was completed by a careful post-mortem examination.
In some instances it may be thought that I have described the clinical history with too much minuteness, and with a fastidious attention to apparently unimportant details; but the question we are now considering is involved in so much obscurity, that it seems to me that it is only by carefully studying the various phases of cases which we have an opportunity of closely watching, that we can hope to contribute anything towards the solution of one of the most complex questions in cerebral pathology—a question about which so much has lately been written, and about which it seems to me so little is at present really known.
It will be observed that in several of the following cases I have given the volumetric analysis of the principal solid ingredients of the urine. This, to some persons, may seem a work of supererogation; to those I would say that the diagnosis of cerebral disease is involved in so much obscurity, that the serious and conscientious observer is bound to avail himself of every collateral aid within his reach; and it cannot be otherwise than useful, systematically to calculate the amount of phosphorus and other constant or occasional solid ingredients of nervous tissue which are daily eliminated from the system.
The following cases present various forms of the affection, from the uncomplicated pure form of aphasiawhere there is simply abolition or suspension of speech without any paralytic or other morbid symptom-to the partial or even occasional impairment of that faculty; and here I would remark that in making investigations with the view of elucidating any obscure symptom or disease, the common error into which many observers fall, is to confine their attention to the consideration of typical cases only-cases where the symptom or disease is well marked and defined; whereas, as much or more information may sometimes be gained from the careful study of exceptional cases, and of cases where the particular symptom or disease is only slightly marked.
Impressed with these views, I have for some time past made careful notes of all cases that have fallen under my observation, where the faculty of articulate language was affected in any way or degree, however slight, deeming it quite as useful to study cases where the lesion of speech is a mere epiphenomenon, as where it forms the principal or the sole morbid symptom.
APHASIA OF THE ATAXIC FORM, OCCURRING EARLIEST MORBID SYMPTOM : SOME MONTHS LATER VERBAL AMNESIA: EPILEPTIFORM CONVULSIONS : ULTIMATELY GENERAL PARALYSIS.
William Sainty, a waterman, aged fifty-one, was admitted under my care into the Norfolk and Norwich Hospital, April 1st, 1865, with the following antecedent history :—He had always lived a temperate and steady life, had never contracted syphilis, nor suffered from any rheumatic affection-in fact, he had always enjoyed excellent health quite up to the period of the present attack, which was not preceded by any premonitory symptoms of brain or nervous disorder. On the 9th of December, 1864, after unloading his vessel, in which he had conveyed a cargo of goods from Norwich to Yarmouth, a distance of thirty miles, he went into a tavern with the intention of asking for some beer, when, to his astonishment and concern, he found he could not speak—the power of articulation was suddenly and completely suspended. Nothing odd or peculiar had been observed in his manner, and he had only a few hours previously called at a merchant's office and arranged about a fresh cargo, when his aptitude for business was in no wise impaired. The loss of speech then was sudden, and was clearly unaccompanied by any other paralytic symptom, for although speechless, he, on the same evening, removed his vessel from one point of the river to another, and on the following day loaded it with a fresh cargo, after which, unaccompanied by any of his friends or comrades, he took the train to Norwich, and on his arrival walked from the railway station to his own home, a distance of a mile. His friends, alarmed at. finding that his vocabulary was limited to the words “Oh! dear! oh! dear!” sent for a surgeon, under whose care he continued till a few days before he came to the hospital. I have not been able to procure any very accurate information as to the precise time during which the abolition of speech was complete; it would seem, however, that after three days he
could say a few words, but that it was not till the expiration of a fortnight that there was any marked improvement; after this period, the progress towards the partial recovery of his speech seems to have been gradual. Sometime in February, he experienced a slight abnormal nervous symptom, characterised by numbness in one of the fingers of the right hand. A month later he had a kind of fit, falling down, and remaining for a few minutes unconscious.
Symptoms on admission.--His condition is that of a healthy looking man, with a remarkably intelligent countenance, looking me straight in the face when addressed, and evidently understanding all that is said ; but although his ideas seem to arise in great number in his brain, and there is no want of sequence in his thoughts, he is unable to give expression to those ideas by articulate language, except in a very imperfect manner. There is, also, partial agraphia, for although just able to form one or two words, he cannot write a sentence, he being able to write fluently and well before the present attack. He has the proper use of all his limbs, which are free from the slightest abnormal sensation. Deglutition is unaffected. The tongue is protruded straight, and he can execute all the different movements appertaining to that organ. The only feature to notice in the tongue is, that the right half is slightly raised above the level of the left half, and is more flabby, and also that when told to protrude the tongue, he keeps it out a long time, as if from a defect of memory, probably not remembering what he had done. There is no abnormal sensation about the head, and the organs of special sense are unimpaired. He is very cheerful, and does not weep from emotional causes, like persons with ordinary paralysis ; nor has he that distressed countenance usually observed in the subjects of grave cerebral disorder. The heart's action is feeble, with occasional intermittence, but no evidence of valvular disease. Pulse, 72. Urine, sp. gr. 1020, freely acid; no albumen, and a volumetric analysis of the principal solid ingredients gave the following result:
So long a time having elapsed since the attack which had