Review of the literature of sensory aphasia, and several cases. Conclusion that the essential central lesion which produces word-blindness is the angular gyros, there being but little evidence tending to show that the supramarginal gyros has anything to do with this phe nomenon. Shaw (Brain, Winter, '93).
Hemianopsia and word-blindness are not necessarily associated. The frequent association of word-blindness with hemi anopsia is explained by the intimate relations existing between the supra marginal convolution and the bundle of optic radiations. In order to explain the absence of word-blindness in right lateral hemianopsia it is necessary to call at tention to the intrahemispheric fibres of the corpus callosum; these latter are injured in subeertical alexia, or pure In order to obtain word blindness without hemianopsia, there must be a lesion of the supramarginal convolution superficial enough to avoid injuring the underlying white fasciculi. Absence of hemianopsia in word-blind ness or total aphasia affords a much more favorable prognosis. Joanny Roux (Revue des Sci. Med. en France et 3 l'Etranger, Apr. 15, '96).
Prognosis. — Word-deafness may con tinue permanently, but it frequently im proves through the co-operation of other sensory centres, and especially the visual centre. The patient, noting the move ments of the lips in those who are speak ing to him, recalls motor images which articulation of the same words would require in him.
Word-blindness does not improve in some cases; in others a painstaking and early re-education may be carried out by which new images may be created in the visual memory by the help of the motor and auditory memories.
Aphasia proper, or aphemia, occasion ally remains the same from the begin ning to the end, no improvement being visible; usually, however, words return very gradually. Recovery, in such cases, is never complete.
Some cases recover almost immedi ately. This almost always occurs in cases of complete aphasia, and would seem to be of dynamic origin, like the mutism of hysteria or of terrified persons.
Case with agraphia, but without alexia, of eight years' standing. During an attack of anger a sudden pain was felt in the head, and this was followed by recovery of speech. Dobie (Lancet, Jan. 9, '92).
In cortical motor aphasia the patient recovers the faculty of reading gradually in the following order: (1) appearance of the word; (2) association of syllables; (3) association of letters forming each syllable. Exact reverse of learning to
read during childhood. Thomas and J. C. Roux (Le Bull. Med., July 10, '95).
Systematic recovery occurs in cases in which the centres of speech are shocked. but not destroyed, by cerebral lesions which cause aphasia. and which grad ually resume their functional activity. A. Mitres (Rev. de Med., Nov. 10, '95).
If congenital aphasia is found in a child under three years, especially if it be rickety or hydrocephalic, the disorder may be due to a simple retardation of development; if the patient is more than three years old the prognosis must be very guarded. Herzen (Revue .lied. de la Suisse Rom., Nov. 20, '95).
Agraphia is, in some cases, recovered from in the sense that the patient learns to write with the left hand. The writing does not resemble that performed with the right hand, and in some cases it is written from right to left, as in mirror writing.
Three cases treated by practice in writing with the left hand; centromotor, marked improvement in a few months; centrosensory aphasia best treated by loud speech or singing. Gutzmann (Deutsche med.-Zeit., Feb. 8, '94).
Supracortical motor aphasia is less serious than cortical motor aphasia, be cause the intelligence is less affected, the centre of language itself being intact and only the path of communication being interrupted.
Recovery occurs more frequently than in cortical motor aphasia.
The prognosis depends on the site and nature of the lesion. Incurable lesions may preclude improvement even in the slighter cases of aphasia. Extensive progressive lesions are, of course, worse than circumscribed ones. Hmmorrhage, embolism, thrombosis, include the ma jority of cases of aphasia. If death does not occur, even the worst disturbances of speech may be recovered from; while, on the other hand, even slight affections of speech may persist throughout the remainder of life. Age is an important factor. Children may learn to speak again even after extensive damage to the speech-centres, whareas small lesions in old people may produce a lasting aphasia. The individual power of learning un doubtedly plays a part in the result. The longer the aphasia has lasted without any tendency to improvement, the worse the prognosis, and this is also the case where the intelligence steadily fails. Karl Bole (Festschr. des Stuttgart. Aerztl. Verein, '97).