Aphasia may occur in uremia, and is at times the sole expression of that state. It is frequently associated with right-sided motor paralysis, hemiplegic or monoplegic in character. It may be the precursor of urfemic convulsions or coma. The aphasia is usually of the motor type, but it may be sensory. There may be word-blindness and word deafness. It may be associated with agraphia, even when there is no paralysis of the limbs. It is comparatively fre pleat in children, particularly in cases of post-scarlatinal nephritis. In adults it may occur in any form of Bright's disease. It is generally transient, dis appearing completely. In time it is in termittent and has a marked tendency to recur. When paralysis is present the two may disappear simultaneously, usually the aphasia first. The features of urfemic aphasia are, per se, not char acteristic of the causal condition. The most important diagnostic features are the transitoriness of the aphasia and the presence of other urremic symptoms and of signs of nephritis. In every case of sudden aphasia. the possibility of its being renal in origin should be consid ered, and careful studies of the urine and of the system at large should be made with this thought in mind. D. Riesman (Med. Record. June 14, 1902).
AGRAPHIA.—Agraphia consists in the loss of the memory of the necessary move ments to write. In an uncomplicated case the patient is able to speak, hear, or read as usual, but when he tries to write he finds that he can no longer do so, though he is capable of copying letters or designs placed before him. Pure agraphia is uncommon. It is usually associated with some degree of aphemia.
Agraphia can only occur in those persons whose education is sufficiently advanced to enable them to write auto matically.
In a thesis written under the direction of Dejerine the following conclusions reached:— The centres of the images of language (motor centres for articulation and visual and auditory centres) are grouped in the convolution about the fissure of Sylvius, forming the zone of language.
Any lesion of this zone g.ves rise to an alteration in the interior language and consequently to manifest or latent alter ations throughout all the modalities of language (speech, hearing, writing) with special predominance over the function of the directly destroyed images. Agraphia is always present. These form the class of true aphasias.
The class of pure aphasias (motor, subcortical aphasia, pure word-blindness of Dejerine, pure word-blindness) ame located outside the zone of language and leave untouched the inner language. They never cause agraphia. and affe-ft only one of the modalities of language. They form a group apart from the true aphasias. Nothing would tend to show the existence of a motor centre for graphic images. Both clinical observa tion and pathological anatomy agree as to its absence.
The existence of pure agraphia has not yet been established. Mirallie (Revue des Sei. Med. en France et fi l'Etranger, July 15, '96).
AmunA.—Sign-language, as practiced by deaf-mutes in gestures and panto ' mimic speech generally, may be affected by a cerebral lesion. Loss of pantomimic speech is often co-existent with aphemia or agraphia or both. It is rarely or ever found alone, although it is quite possible to conceive of its separate existence in one in whom this faculty had been espe cially cultivated. (Mills.)