When recovery occurs, it does usually systematically and progressively ; the language that first returns is usually the one first learned. The patient begins by understanding before being able to speak. At times, however, there occurs an arrest in the process of recovery: the patient in such a case recovers only the ability to understand and then to speak the language usually spoken by him. or he may understand one or several lan guages, but be unable to speak them.
In such cases it is evident that there is no destruction of the cortical centres of speech, but only of shock to their elements. The varying intensity of such shock explains the gradation of the symptoms noted in the patients seen by the writer.
Consequently it is rot, in general. necessary to claim the existence of multiple centres of speech. each one peculiar to one of the languages success fully learned by patients speaking sev eral languages. The paper is based on seven observations. A. Pitres (Rev. de Alert., Nov., '95; Revue des Sci. Med., Case in which the patient, who had been under almost continuous observa tion for eighteen years, was almost com pletely aphasic. At the autopsy Broca's convolution was found to be intact. ' Bastian (Lancet, Dec. 19, '96).
Case of motor aphasia at the begin ning of scarlatina, in a girl aged years. The aphasia appeared on the fourth or fifth day of the eruption; this differs from the usual time of appear ance, which is late: i.e., about the time of appearance of renal symptoms, it be ing a symptom of urxmia. The speech disturbance disappeared after fifteen days. Brasch (Berliner klin. Woch., No. 2, S. 30, '97).
Case in which the symptoms were word-deafness, verbal amnesia, jargon paraphasia, paralexia, loss of compre hension of print, and agraphia, with retention of ability to copy Roman letters into script and with no visual defect whatever. The impairment of all ways of using language, so often ob served as a result of auditory lesion, due to the fact that the auditory centre is normally active in spontaneous speech, reading, and writing, as well as in the comprehension of speech. II. T. Pershing (Boston Med. and Surg. Jour., Sept. 23, Case of aphasia with frequent attacks of word-deafness and spasm of the right side of the tongue and face. At autopsy tumor was found in the lower part of the Rolandie fissure resting upon the first temporal convolution. Philip Zen ner (N. Y. Med. Jour., Jan. 8, '9S).
Pathology.—Moron APHASIA.—Pure aphasia of articulation is due to a lesion of the foot of the third left frontal con volution (Broca's convolution). If the lesion affects more than this region, other symptoms are present. If the lesion occupy but a portion of the region, the aphasia may be partial only: for in stance, nouns only will be missing. In persons habitually left-handed a lesion of the third right frontal convolution may produce motor aphasia. In persons who are ambidextrous the aphasia is of slighter degree and is more transient. The lesion may be either cortical or sub certical. As a rule, in the subcortical cases the defect is rarely complete.
Case in 4-year-old child. At the au topsy several tubercular nodules were found in brain, one being at the base of the left third frontal gyrus. Mosny (Bull. de la Soc. Anat., Mar., '88).
Case, lasting ten years, with distinctly causative subcortieal lesion. Horizontal section through Broea's convolution showed at its base an old focus of soft-, ening, 1 centimetre in diameter and 2 centimetres from the cortex; 1 centi metre farther back was a second focus. A section 1 centimetre above the first showed an ancient, grayish focus in the white substance, on a level with the anterior half of the base of the third frontal, independent of the other two and on a plane anterior to them.
Second case, with centre of softening in the white substance to the third fron tal, prolonged, on a. level with the in ferior extremity of the Rolandic fissure, into the foot of the ascending frontal convolution. Dejerine (La Semaine Med., Mar. 4, '91).
Case of complete motor aphasia conse quent on fall. Ability to use right hand to write; left hemiplegia. At autopsy left hemisphere found normal; right hemisphere injured. The man had never been left-handed. Luys (La Semaine Med., Mar. 19, '91).
Case of motor aphasia (partial) with agraphia (complete), alexia (partial), and occasionally auditory aphasia. Right hemiplegia. Vast focus of softening in the left hemisphere. Motor aphasia ex plained by destruction of the third left frontal ; motor agraphia by destruction of white matter connecting inferior pa rietal with second left frontal; partial auditory aphasia by destructive lesion involving first temporal lobe. Incom plete alexia due to destruction of inferior parietal lobe. Bernheim (Revue de Med., May 10, '91).