Treatment.—When there is no paral ysis present mental overwork is a fre quent cause of aphasia. Prolonged rest alone secures relief. Any disorder, con comitant or causative, that may be pres ent should receive careful attention. At the same time the patient should be taught to overcome the aphasic symp tom; considerable patience is usually re quired. When the aphasia is associated with right-sided paralysis or convulsions, the treatment of the latter condition by alteratives, potassium iodide or mercury if a syphilitic taint be present, some times brings about rapid recovery.
Case combined with amimia, the result of a kick of a horse on left parietal bone. Six weeks later, on examination, the patient was found without fever, pulse normal, appetite good, eyes and ears normal, and no paralysis, except of the fingers of the right hand. Over left parietal bone were three ulcers, the low est of which was two centimetres over the left ear. It was about three centi metres long, equally wide, bulged out, and showed distinct cerebral pulsation. The cranial vault was depressed about the ulcers. The depressed portions of bone were removed, the corresponding defect being covered with two flaps, after von Bergmann's plastic method. The paralysis of the hand disappeared rap idly, followed by complete restoration of speech on the twenty-second day. Rosenberger (Ccntralb. f. Chin, No. 25, '90).
Remarkably instructive case of nine years' standing. By educating the right hemisphere, within six weeks acquire ment of a vocabulary of over one hun dred words and several invaluable short sentences. Kuchler (Pritger med. Woch., Oct. IS, '93).
Case cf urremie aphasia. The patient, a man of 56, was suddenly seized with an apoplectic attack: he regained conscious ness, but presented aphasia. monoplegia of the right arm, and a systolic murmur at the base of the heart. Some days later the patient was seized with a sud den attack of intense dyspncea, with Cheyne-Stokes respiration ; the urine was scant and very albuminous, and the blood contained seventy-five centi grammes of urea to the litre. The pa tient was bled immediately and recov ered in two days, the monoplegia and the aphasia completely disappearing. Bendu (Gaz. Med. de Paris, Apr. 4, '96).
Case of complete agraphia and almost complete word-blindness, with right-sided bilateral temporal hemianopsia, due to a lesion (gumma) in the region of the left angular gyrus, in which rapid and complete disappearance of all the symp toms took place under the administra tion of large doses of iodide of potassium.
Byrom Bramwell (Lancet, Mar. 20, '97).
The treatment of amnesic aphasia lies in efforts to stimulate the defective recol lection of words. The words must be learned by heart, and then short reading exercises adopted. The exercises should be performed in front of a mirror, in order to restore the recollection of the necessary movements. In motor aphasia other parts of the brain may take on function. Single sounds, then syllables, and lastly words are taught. Writing exercises with the left hand should be performed along with the articulation exercises. The patient should be taught to form words from printed letters. The treatment of sensory aphasia is more difficult. The first attempts are made by means of written language. Lip-reading should be developed, and reading, writ ing, and other exercises combined with it. The case may be n.uch complicated by a combination of different forms of aphasia. Much patience is required. Karl Bole (Festschr. des Stuttgart. Aerztl. Verein, '97).
Injury to the skull, especially when there is depression of the inner plate, tumors, cerebral limmorrhage, and other conditions capable of inducing cerebral pressure require appropriate surgical procedures.
Case combined with paraphasia greatly benefited by trephining. Fogliano (Gaz. deg. Osp., No. 4, '91).
Cases illustrating the value of opera tive measures:— Case of mind- and word- deafness after repressed fracture of the skull with sub cortical hmmorrhage; operation; com plete recovery.
Case of glionia cf the left centrum ovale, monoplegia, word-blindness, alexia, agraphia, partial apraxia, and color blindness; operation ; improvement.
Case of cyst of the brain in the foot of the left second frontal convolution; motor agraphia ( ?) from inability to spell; evacuation of the cyst; improve ment; traumatic meningeal lmmorrhage two months later; second operation; recovery.
Case of oro-lingual paralysis and slight motor disturbance in writing of throm botic origin; operation; recovery.
Case of motor and sensory aphasia of seven years' duration, due to probable thrombosis followed by angioma; opera tion; relief of pain; slight improvement in speech. J. T. Eskridge, Clayton Park hill, and E. J. A. Rogers (Med. News, June 20; July 11; Aug. 1, 15; Sept. 5, '96).