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The Pathology of Aphasia

Published online by Cambridge University Press:  19 February 2018

Alexander Robertson*
Affiliation:
Lunatic Asylum, Glasgow

Extract

To the students of mind in its healthy as well as in its diseased condition, the doctrine that certain portions of the brain are associated with particular mental powers is necessarily one of engrossing interest. Until lately, however, the facts advanced in support of the existence of this association have been so inadequate, that the majority of thinkers have regarded the doctrine itself, maintained as it has been with so much zeal by Gall and his followers, to be little more than a theory, no doubt probable enough, but deficient in that solid basis of proof which alone could warrant its acceptance on any higher ground. But it has recently been confidently asserted that evidence is at last forthcoming that the organ of one faculty, the faculty of articulate language, has now been discovered. Still, the alleged discovery, though it were established, would give only qualified support to the phrenological view just referred to, as, contrary to all preconceived notions derived from the bilateral symmetry of the brain, the supposed organ is declared to be situated on its left side alone. Conclusions of so weighty moment evidently require that the validity of their premises should be thoroughly tested; and it is in the hope that I may be able in some degree to show how far they are trustworthy, that I have ventured to bring the facts and considerations embodied in the following paper under the notice of this Society.

Type
Part I.—Original Articles
Copyright
Copyright © Royal College of Psychiatrists, 1867 

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References

I may remark that I showed this person to Sir James Coxe, on the occasion of his official visit to the City Parochial Asylum, in the month of April.Google Scholar

By the term reasoning, I mean the discursive faculty we possess of deducing conclusions from premises, distinguishing it from the more comprehensive powers which reason is understood to imply. Dugald Stewart remarks that this distinction has not always been clearly kept in view by metaphysicians.—Philosophy qf the Suman Mind, p. 288.Google Scholar

‘Lectures on Clinical Medicine,’ by A. Trousseau; translated by P. Victor Bazire, M.D.; p. 273.Google Scholar

‘Analysis of the Phenomena of the Human Mind’ vol. i, p. 84.Google Scholar

Ibid., p. 202.Google Scholar

§ Ibid., p. 218.Google Scholar

‘Lectures on the Science of Language’ by Max Müller, M.A., 2nd series, p. 62.Google Scholar

£ Quoted by Max Müller, ibid., p. 72.Google Scholar

∗∗ Ibid., p. 73.Google Scholar

‘Lectures on Clinical Medicine’ by A. Trousseau; translated by P. Victor Bazire, M.D.; p. 271.Google Scholar

Ibid., p. 230 et seq.Google Scholar

#x2018;On the Function of Articulate Speech,’ &c.; being a paper read before the Phil. Society of Glasgow, March 7,1866; p. 8.Google Scholar

§ ‘Lancet’ June 16, 1866.Google Scholar

This nominalutic view of the union of thought and language is not, however, universally received.Google Scholar

P. 488.Google Scholar

Since writing this paper, I have had another aphasie patient under my care in whom the feature referred to here was distinctly marked. Most words he completely failed to pronounce. He was annoyed at his failures, and much pleased when on two or three occasions he succeeded in his attempts at articulation. I specially remarked in this case that the emotional powers were much weakened, even as greatly as in the majority of cases of hemiplegia without aphasia. Thus, his voice quivered and he began to shed tears when I was questioning him. This is opposed to Trousseau's view, who holds—and, I think, correctly, in most cases—that in aphasia the emotions are little, if at all, affected.Google Scholar

‘Diagnosis of the Brain,’ &c., by J. Russell Reynolds, M.D., p. 239.Google Scholar

‘Lectures on Clinical Medicine’ p. 261.Google Scholar

‘The Function of Articulate Speech’ p. 20. The italics are his.Google Scholar

‘Lectures on Clinical Medicine’ p. 262.Google Scholar

§ ‘London Hospital Reports,’ vol. i, 1864, p. 400.Google Scholar

Since writing the above, Dr. Crichton Browne, Medical Superintendent of the West Riding Asylum, mentioned to me that he had lately under his care a case of Irft hemiplegia in which there was almost complete loas of language.Google Scholar

I may state that Dr. Barbour, a gentleman of considerable experience in necro8copical examinations, assisted me in making the inspection.Google Scholar

The membrane was shown and the case described at length at the June Meeting of the Medico-Chirurgical Society in Glasgow. Since writing the above, 1 have inspected another very similar case, except that in it the false membranes extended over both hemispheres. The arachnoid and pia mater were even more thickened, and the latter was distinctly adherent in many places to the cortical substance, markedly so over the left external frontal convolution. Under the microscope, sections of grey matter from this convolution, and also from the surface of the island of Reil, presented many cells in a state of fatty degeneration. The symptoms were those of great mental weakness, with a degree of general paralysis; but there was no aphasia.Google Scholar

It is not necessary to suppose that the same fibres in every case act as the conductors for the incitations which give rise to language, as speech is an acquired faculty; so that possibly different fibres in different persons may transmit the impulses for words, provided only they are connected with the co-ordinating centres for articulation. If this were so, a lesion of precisely similar situation in two persons which caused aphasia in the one might not implicate speech in the other.Google Scholar

The view of the aphasie lesion explained in this paper was communicated by me, in the beginning of last April, to a meeting of the M edico-Chirurgical Society in Glasgow, on the occasion of the reading of a paper on the subject by Dr. W. T. Gairdner. At that time I was not aware that an explanation in any degree similar had been previously proposed. However, in the French ‘Journal of Mental Medicine’ referred to in the text, and perused by me in the month of Jane, I noticed that MM. Letourneau and Cerise had suggested that aphasia may partially be due to a defect in transmission; but they hold that there are other causes—Letourneau says there are five different ones. Certainly, the hypothesis as stated by them did not meet with general acceptance. Trousseau's view is, I think, at present, the one generally received—that the principal defect is amnesie. On the other hand, as I have said, my opinion is, that the lesion is essentially a motob one.Google Scholar

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