unwise to study aphasia as if it were a malady per se; it is clearly only a symptom, and not a pathological entity having a proper place in any nosological classification. Whilst fully admitting this, however, I maintain that, for the purposes of scientific inquiry, it is convenient at present to study loss of speech-as many other investigators are doing-as if it were really a morbid entity; for in many of the cases I have reported it was the sole abnormal symptom present. Besides, the faculty of articulate language is the great distinction which the Creator has made between man and the lower animals; it is one of the highest of human attributes, and there is no subject more worthy of the attention of the philosophical physician than the investigation into the causes which interfere with the proper use of this faculty. I shall, therefore-as it were under protest, and as a matter of convenience-consider aphasia under the various heads of Causes, Varieties, Treatment, &c.

SYNONYMS. Few subjects in medical philology have given rise to so much discussion as the name by which loss of the faculty of articulate language should be scientifically designated; a brief allusion, therefore, to the various names proposed cannot be omitted. The term Anaudia was used by the Greek physicians for loss of speech, and the adjective avavdos is employed by Eschylus.* Alalia is used by Sauvages, Frank, and

others, and Professor Lordat* in describing his own case employed the word "Alalie," which latter term has also been adopted by M. Jaccoud. In 1861, M. Broca, when relating to the Anatomical Society of Paris his two remarkable cases, which have since excited so much interest throughout the scientific world, used the word "Aphémie" (a pn). This last expression has latterly given way to Aphasia, a word adopted by M. Trousseau, who is supported in his preference for it by no less an authority than M. Littre.† Other names such as Aphrasia, Aphthongia, Aphthenxia, &c., have been suggested. Aphasia, doubtless from its simplicity and euphony, is now the favourite expression; it is the one I have selected, and in accordance with the neological phraseology of the day, I shall adopt the terms-Amnesic, Ataxic, and Epileptiform Aphasia, &c.

DEFINITION. The word aphasia has been used in a different sense by different authors; some, like Trousseau, Broca, Auguste Voisin, &c., limit its use to

* "Analyse de la Parole pour servir à la théorie de divers cas d'Alalie et de Paralalie." 1843.

This word occurs twice in Homer; Iliad xvii., 695; and Odyss. iv., 704; the text being precisely the same in both instances—

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· δὴν δέ μιν ἀμφασίη ἐπέων λάβε;” here speechlessness from emotional causes is evidently implied.

Dr. Popham, of Cork, considers that of all the words in the Greek language denoting modes of speech, the verb 40éyyoμaι applies more than any of the others to the formation by the tongue of articulate sounds. The substantive peyğıs is used by Hippocrates, and the privative word apoéysis would express an inability to enunciate syllables. He also thinks that the English word aphthenxia is as euphonious as many other derivations from the Greek.-Dublin Quarterly Journal, November, 1865.

designate that condition in which the intelligence is unaffected, or at all events but slightly impaired ; where thoughts are conceived by the patient, but he cannot express himself, either because he has lost the memory of words, or because he has lost the memory of the mechanical process necessary for the pronunciation of these words; or because the rupture of the means of communication between the grey matter of the brain and the organs whose co-operation is necessary to produce speech, does not allow the will to act upon them in a normal manner-the ideas are formed, but the means of communication with the external world do not exist. This definition would exclude all cases in which loss or lesion of speech was due to the alteration of the peripheral organs which co-operate for the production of sounds, as well as those in which the embarrassment of speech was attributable to a general lesion of the intelligence, such as idiotism, cretinism, deaf-mutism and the different forms of mental alienation.

I prefer, however, using the word in its strictly etymological sense—a paσio—and I would thus apply it to all cases where speech is abolished or suppressed from whatsoever cause, believing that it is more convenient for the purposes of pathological research, thus to consider lesion of speech in its general and widest sense. This interpretation of the word necessitates divisions and sub-divisions in which all shades and degrees of the affection may be included, and it has enabled me, in the preceding pages, not only to admit cases where the lesion of speech was decided and more or less permanent, but also those where it appeared only as an epiphenomenon, believing, as I have before

stated, that such cases may be more useful than the typical cases which are so frequently put on record.

Before alluding to any subdivision of the subject, I would, just for one moment, ask what speech is?

Speech is a complex faculty consisting of two distinct elements, one physical, somatic, and material—a movement; the other psychical, the interior speech-the Xóyos; and we must take care not to confound this inward with the outward speech or articulation, which is only a form of expression. Here I must remark that it is important not to confound the faculty of articulate language with the general faculty of language, and Professor Broca's remarks on this subject are so lucid and terse, and of such a philosophical character, that I cannot do better than transcribe them.-"There are several kinds of language; every system of signs which permits the expression of ideas in a manner more or less intelligible, more or less complete, or more or less rapid, is a language in the general sense of the word: thus speech, mimicry, dactylology, writing both hieroglyphic and phonetic, are so many kinds of language. There is a general faculty of language which presides over all these modes of expression of thought, and which may be defined-the faculty of establishing a constant relation between an idea and a sign, be this sign a sound, a gesture, a figure, or a drawing of any kind. Moreover, each kind of language necessitates the play of certain organs of emission and reception. The organs of reception are at one time the ear, at another the eye, and sometimes the touch. As to the organs of emission, they are brought into play by voluntary muscles such as those of the larynx, of the

tongue, of the velum palati, of the face, of the upper limbs, &c. Every regular language, then, presupposes the integrity: 1st-of a certain number of muscles, of motor nerves which supply them, and of that part of the nervous system from which these nerves arise; 2nd-of a certain external sensorial apparatus, of the sensitive nerve which supplies it, and of that part of the central nervous system with which this nerve is connected; 3rd-of that part of the brain which presides over the general faculty of language, such as it has just been defined. The absence or abolition of this faculty renders all kinds of language impossible."*

The elementary form of language which exists from earliest infancy, and amongst all people and races, is gesture; the child points to certain objects and persons, this being a sign of recognition of something that had previously made an impression on the optic nerve-in fact a proof is given of the existence of the faculty of memory; the parent now steps in, and the child is taught to connect certain objects and persons with certain conventional signs or symbols called words, and in order to effect this the auditory apparatus must concur, and speech is the result-the faculty of articulate language is for the first time roused into action.

Certain conditions, however, are indispensable for the development of articulate language: 1st-there must be integrity of thought, or at all events an idea must be conceived; or, as Mr. Dunn elegantly remarks, "must be moulded for expression in the seat of intellectual actions." 2nd-there must be a connexion between the idea conceived, and the conventional signs

"Sur le Siége de la Faculté du Langage Articulé," p. 4.