APHASIA.
This speech difficulty need receive no attention till the treatment of the cerebral lesion causing it has demonstrated that the hemorrhage, em bolism, or thrombosis is no longer active or has ceased to extend. In functional cases, as in hysteria and post-epileptic aphasia, treatment is seldom necessary, the speech centres soon regaining their power spon taneously. It is different where permanent damage has occurre 1, and the hope of articulation being restored must lie in efforts being made to call into action the dormant speech centres in the sound cerebral hemi sphere (usually the right one); but if the commissural fibres are destroyed there is little or no result to be expected.
In motor aphasia, where the patient remains perfectly conscious of all that is said to him, but is only able to reply in meaningless, short ejacu lations, he should be educated to write with his left hand by copying printed or written sentences when the power of writing remains with him. The simplest speech movements are to be taught patiently several times a day, beginning, as in the case of a child, with the spelling and articulation of letters and short monosyllables, his oral education being supplemented by exercises in writing and reading short sentences. (In left-handed patients the right speech centres are in daily operation, and these, of course, escape when the damage is confined to the left side of the brain.) In young subjects by persistent education of the right speech centres articulation may be entirely restored, and even in older patients the same result is sometimes witnessed when the callosal fibres have com pletely escaped in the primary lesion, and industrious perseverance in copying and speech exercises has been conscientiously carried out and the use of his left hand encouraged in every way possible.
In sensory aphasia from cortical lesions the difficulty of treatment is greater. If this be of the auditory type the patient is word-deaf and unable to write from dictation; though he hears the sounds of the words spoken to him they appear as in a foreign tongue, and as his power of articulation may be good he uses the wrong words, unconscious of his mistakes. The
only method of treatment in this condition consists in repeated exercises of pronouncing words which are written or printed when the eve of the patient is kept fastened upon the word; afterwards the object represented by the word may be shown to him, as a cat, dog, pin, &c., and he should be encouraged to repeat its name frequently.
In subcortical or pure word-deafness the auditory speech centre remains intact, internal speech is unimpaired, and the patient can express himself perfectly in writing or vocally, and though he is unable to understand or repeat spoken language he can read aloud perfectly.
When sensory aphasia is of the visual type (alexia), the patient is capable of spontaneous speech, and comprehends spoken words, but he fails to understand written and printed language, and he cannot write or copy intelligently, though his central vision is perfect, and he cannot read aloud. In this condition the only treatment is such as is employed in education of the blind, supplemented by training the patient to write with his eyes closed, or to write in the air with his index-finger, and to trace over each letter with a pencil or by means of his finger, by which latter method he is only able to understand or read his own writing.
The nudism which follows shell-shock yields usually to time, encourage ment and in severe cases to hypnotic suggestion. When the inhibition has been more profound the patient may have lost the meaning of words which he hears or sees in writing or piint. The treatment in these severe cases must be carried out on the lines indicated above.