APHASIA (Gr. a, not, and phasis, speech) is a term adopted by the eminent French physician, Trousseau, to denote a remarkable symptom of certain conditions of the ner vous system in which the patient is more or less unable to express his thoughts in speech. The disease has been casually noticed by many earlier observers, amongst whom. Dr. Parry of Bath may be especially noticed; but it was not until within the last 20 years that it has received the attention which its great singularity demands. Before receiving its present name, it had been termed aphemia (from a, not, and phemi, I speak), and alalia (from laleo, I talk). Voisin, in an elaborate memoir on this subject, published in 1865, observes that it may be due to several causes. It may be congenital or acquired, and in the latter case is due to some form of lesion or injury of the anterior lobes of the brain. This fact was observed as long aga as 1825 by Bouillaud; but in 1861, during a discussion of the anthropological society of Paris, as to whether certain faculties, such as language, are or are not in special parts of the brain, Broca advanced the view, that the faculty of language has its seat not only in the anterior lobes, but in the left lobe, and occupies exactly the external left frontal convolution, where the anterior lobe meets the middle lobe immediately in front of the fissure of Sylvius. This singular conclusion was deduced from only two post-mortem examinations which had just occurred at the Bicetre, but a number of previously published cases sup ported it; and Dr. Hughlings Jackson, of • the London hospital, "has seen about seventy cases of loss or defect of speech with hemiplegia, and in all but one, the hemiplegia was on the right side, indicating disease of the left side of the brain."— Lancet, Nov. 26, 1864. Moreover in the two cases which during the year last named proved fatal in the Edinburgh and Glasgow infirmaries, Dr. Sanders and Dr.Gairdner traced the disease to the exact spot described by Broca. It may be caused by wounds. tumors of various kinds, including hydatids, or by softening of the left anterior lobe, and has occasionally, but very rarely, been found in association with lesions of other parts of the cerebrum, and even of the cerebellum and spinal cord. According to Voisin, in 146 cases, the left anterior lobe was affected in 140, and the right in only 6 cases. A variety of aphasia has been noticed in typhoid fever and in the first stage of small-pox; also in certain chronic cachexias or intoxications, as for example, in syphilis and chronic alcoholism; and there are cases in which the affection is purely nervous, and results from epilepsy, an overtaxed brain, etc. The patients in whom true aphasia from disease of the brain occurs, are excellently described by Dr. Gairdncr in his essay On the Functions of Articulate Speech, etc. (Glasgow, 1866). This description, in a con densed form, is as follows: These patients have been the subject of some form of dis turbance of the cerebral functions, sometimes with, but sometimes also without a mani fest disturbance of the intellect. It may have been epilepsy or apoplexy, in which latter
case, as has been already noticed, there is often paralysis, almost invariably on the right side of the body. This paralysis may be of any extent of completeness, but in many cases the patient has such command over the movements of the townie and lips, as to show that it is not from paralysis his speech is affected. The states of intellectand con sciousness are equally variable the patient occasionally appearing and behaving as if he were in perfect bodily and mental health, except for the aphasia. - Moreover, the aphasia itself shows itself in the most varied forms. In the more trivial cases, it is little more than an aggravation of the common defect of forgetting, or being unable to recall the name of a person or thing when wanted. Dr. Gairdner records the case of what he calls " an aphasic," who could conduct an ordinary conversation pretty well, but who could not name the days of the week, and would, for instance, call Monday " the first work ing-day," and who had forgotten, or could not give utterance to his own name. Some times a patient will perfectly articulate such expressions as these: " I want —, I want —,Where's the"—, almost always stopping short at the name of the object. Sometimes the patient's vocabulary is limited to one or two common words, as "yes" or " no ;" or perhaps lie utters only one or more unintelligible words, as in the case of one of Trous seau's patients, who for four months uttered nothing 179t " Cousisi" to every possible question, unless when in moments of great irritation, and he would then articulate "Saxon, sacon"—probably an abbreviation for a French oath. Strange to say, certain aphasics who can articulate absolutely nothing else, can swear with perfect facility. Such exclamations as " Oh!" " Dear me I" "God bless my life!" and " D—n it!" are often the only utterances of these patients. Dr. H. Jackson, in a memoir on aphasia, in the first volume of the London Hospital Reports, has made some excellent remarks on this peculiarity, which are well worthy of perusal by all who study mental philosophy. He ingeniously regards an oath not as a part of language, but as "a sort of detonating column." The general reader may also read with advantage the histories of two cases recorded by Trousseau, in which Frenchmen of high mental capacity, and well acquainted with the disease (one of them an eminent physician in Paris, who had specially studied the diseases of the brain; and the other, prof. Lordat of Montpellier), have passed through attacks of aphasia, have recovered, and have described their own cases.
Aphasia may be either temporary or persistent; in the former case, being due to loss of nervous energy, congestion, or some other functional disorder; while in the latter case, it is probably associated with disease of structure. It is unnecessary to describe the treatment, which varies according to the peculiarity of each individual case, and must be left solely in the hands of the physician. •