by A. Flint, H. B. Wilbur, E. C. Seguin, and others, in this country. According to recent observers, the most frequent lesion in aphasia is in the parts supplied by the left middle cerebral artery, particularly the lobe of the insula, or the island of Reil; and it is a curious fact that this part is found only in man and monkeys, being in the latter very slightly developed. While we must agree with Dr. Hammond in the statement that the organ of language cannot be absolutely restricted to these parts, it is none the less certain that they are most frequently the seat of lesion in aphasia.

As illustrating the loss of the faculty of speech without any marked impairment of the intellectual faculties, we can cite numerous cases recorded by Dr. Hammond. A woman is described as presenting a countenance remarkably bright and cheerful, her whole expression being exceedingly intelligent. "She comprehends every word that is said to her, and attends to all her household duties. Yet she is unable to utter any words but no,' 'yes,' and 'dado.'" Other cases are given, in which the intellect seemed to be clear, but in some, the faculty of speech was lost, and in others, both the faculty of speech and of writing. One case reported by Dr. Hammond is so striking that we give it in full:

"The patient was a retired officer of the army, and consulted me in the autumn of 1869 for paralysis, vertigo, and slight difficulty of speaking, from which he had suffered for some months. Several years previously he had been under the care of my friend Dr. Metcalfe, for acute rheumatism, with cardiac complications. The history of the case pointed strongly to embolism, and, as the paralysis affected the right side, I diagnosticated a previous attack of embolism of the left middle cerebral artery.

"The difficulty of speech was slight; there were both amnesic and ataxic aphasia.

"Under the treatment employed he improved very much

1 1 Op. cit., p. 210.

in the ability to walk, to use his arm, and to speak, so much so, that he and his friends considered him better than he had been for several years. But, about six weeks after he came under my charge, he had another attack. This time. the left side was paralyzed, and there was no difficulty of speech. Galvanism was employed, as before, and he recovered sufficiently to go to Washington City. While there, he had a third attack, characterized by right hemiplegia and aphasia. He soon recovered his power of speech, and soon afterward had a further attack, involving the left side, and unattended by aphasia. He recovered under the care of Dr. Basil Norris, of the army, and soon afterward came again to New York. A short time after his arrival I requested my friend Prof. Flint to see him in consultation, with the special view of having him examine his heart. This was done with thoroughness, but no abnormal sounds were detected. While in New York he had two other attacks, during both of which he was delirious; both were characterized by hemiplegia. That of the left side was unaccompanied by aberrations of language; that of the right side was attended with ataxic and amnesic aphasia. He forgot the names of the most ordinary things, and there were many words that he could not articulate at all. Thus, when he wanted a fan, he called it a large, flat thing, to make wind with.' He forgot my name, and could not pronounce the words beetle, general, physician, and many others. I sent him to Newport greatly improved, but he had other attacks there, and finally died in the autumn of the present year, of, I presume, cerebral softening.

"The interesting features of this case are the concurrence of hemiplegia and ataxic and annesic aphasia, and the striking fact that there was no aphasia when the paralysis involved the left side. Thus, according to my views of the case, the patient had repeated attacks of cerebral embolism. When the embolus lodged in the left middle cerebral artery, there was aphasia accompanied by right hemiplegia; when

the embolus obstructed the right middle cerebral artery, there was left hemiplegia, but no aphasia."1

An analysis of a large number of cases of aphasia recorded by different observers shows that the great majority occur in connection with right hemiplegia. Dr. Hammond quotes 243 cases with right, against 17 cases with left hemiplegia. In cases verified by post-mortem examination, 514 occurred when the lesion involved the left, and 31, when it involved the right anterior lobe. Dr. Hammond cites additional cases, in 80 of which the lesion involved the left lobe, and in 2, the right lobe.

While the above facts show that the cerebral lesion in aphasia involves the left anterior lobe in the great majority of cases, there are several instances in which the right lobe alone was affected; and this has led physiologists and pathologists to deny the absolute location of the organ of language on the left side. Even if we reject a certain number of cases of aphasia with the brain-lesion limited to the right side, in which we may suppose that the post-mortem examinations were incomplete, or the impairment of speech was due, perhaps, to simple paralysis of muscles, we must admit that, in a few instances, aphasia has followed injury or disease of the brain on the right side. Aside from the anatomical arrangement of the arteries, which seem to furnish the greater amount of blood to the left hemisphere, it is evident that, as far as voluntary movements are concerned, the right hand, foot, eye, etc., are used in preference to the left; and that the motor functions of the left hemisphere are superior in activity to those of the right. It would be interesting, then, to note the physical peculiarities of persons affected with left hemiplegia and aphasia. Dr. Bateman quotes two cases of aphasia dependent upon lesion of the right side of the brain and consequent left hemiplegia, in which the persons were left-handed; and these, few as they are, are interesting, as showing that a person may use the right side 2 HAMMOND, op. cit., p. 215. BATEMAN, On Aphasia, London, 1870, p. 164.

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of the brain in speech, as in the other motor functions. In this connection, it may not be uninteresting to note that, although most anatomists have failed to find any marked difference in the weight of the two cerebral hemispheres, Dr. Boyd has shown by an "examination of nearly two hundred cases at St. Marylebone, in which the hemispheres were weighed separately, that almost invariably the weight of the left exceeded that of the right by at least the eighth of an ounce." To conclude our citations of pathological facts bearing upon the location in the brain of the organ of speech, we may refer to an account, by Dr. Broadbent, of the brain of a deaf and dumb woman. In this case, the brain was found to be of about the usual weight, but the left third frontal convolution was of "comparatively small size and simple character.” 2

Taking into consideration all of the pathological facts bearing upon the subject, it seems certain that, in the great majority of persons, the organ or part presiding over the faculty of articulate language is situated at or near the third frontal convolution and the island of Reil in the left anterior lobe of the cerebrum, and mainly in the parts nourished by the middle cerebral artery. In some few instances, the organ seems to be located in the corresponding part on the right side. It is possible that, originally, both sides preside over speech, and the superiority of the left lobe of the brain over the right and its more constant use by preference in right-handed persons may lead to a gradual abolition of the functions of the right side of the brain, in connection with speech, simply from disuse. This view, however, is hypothetical, but is rendered probable by certain considerations, among the most important of which is the statement by

1 BOYD, Table of the Weights of the Human Body and Internal Organs.— Philosophical Transactions, London, 1861, vol. cli., part i., p. 261.

2 BROADBENT, On the Cerebral Convolutions of a Deaf and Dumb Woman.Journal of Anatomy and Physiology, Cambridge and London, 1870, vol. iv., p. 225..

Longet, that "one cerebral hemisphere in a healthy condition may suffice for the exercise of intelligence and the external senses." In support of this statement, Longet cites several cases of serious injury of one hemisphere without impairment of the intellect."

Another very important point, which we believe had never before been noted, is brought forward very strongly by Dr. Hammond. In what is called the ataxie form of aphasia, the idea and memory of words are intact, and there is simply loss of speech from inability to coördinate the muscles concerned in articulate language. Patients affected in this way cannot speak, but can write with ease and correctness. In the amnesic form of the discase, the idea and memory of language are lost; patients cannot speak, and are affected with agraphia, or inability to write. In cases in which hemiplegia is marked, the aphasia is of the ataxic form; while in cases in which there is no hemiplegia, the aphasia is amnesic.

"The gray matter of the lobes presides over the idea of language, and hence over the memory of words. When it only is involved, there is no hemiplegia, and there is no difficulty of articulation. The trouble is altogether as regards the memory of words.

"The corpus striatum contains the fibres which come from the anterior column of the spinal cord, and is besides connected with the hemisphere. A lesion, therefore, of this ganglion, or other part of the motor tract, causes paralysis of motion on the opposite side of the body. The cases I have detailed show, without exception, that the power of coördinating the muscles of speech is directly associated with this hemiplegia. A lesion, therefore, followed by hemiplegia and ataxic aphasia, indicates the motor tract as the seat. If amnesic aphasia is also present, the hemisphere is ikewise involved."

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1 LONGET, Anatomie et physiologie du système nerveux, Paris, 1842, tome i., p. 666, et seq. 2 HAMMOND, op. cit., p. 217.