ing way how numerous the associative paths are which all end by running out of the brain through the channel of speech. The hand-path is open, though the eye-path be closed. When mental blindness is most complete, neither sight, touch, nor sound avails to steer the patient, and a sort of dementia which has been called asymbolia or apraxia is the result. The commonest articles are not understood. The patient will put his breeches on one shoulder and his hat upon the other, will bite into the soap and lay his shoes on the table, or take his food into his hand and throw it down again, not knowing what to do with it, etc. Such disorder can only come from extensive brain-injury.* The method of degeneration corroborates the other evidence localizing the tracts of vision. In young animals one gets secondary degeneration of the occipital regions from destroying an eyeball, and, vice versa, degeneration of the optic nerves from destroying the occipital regions. The corpora geniculata, thalami, and subcortical fibres leading to the occipital lobes are also found atrophied in these cases. The phenomena are not uniform, but are indisputable;+ so that, taking all lines of evidence together, the special connection of vision with the occipital lobes is perfectly made out. It should be added that the occipital lobes have frequently been found shrunken in cases of inveterate blindness in man. Hearing. Hearing is hardly as definitely localized as sight. In the dog, Luciani's diagram will show the regions which directly or indirectly affect it for the worse when injured. As with sight, one-sided lesions produce symptoms on both sides. The mixture of black dots and gray dots in the diagram is meant to represent this mixture of 'crossed' and 'uncrossed' connections, though of course no topographical exactitude is aimed at. Of all the region, the temporal lobe is the most important part; yet permanent absolute deafness did not For a case see Wernicke's Lehrb. d. Gehirnkrankheiten, vol. II. p. 554 (1881). The latest account of them is the paper Über die optischen Centren u. Bahnen' by von Monakow in the Archiv für Psychiatrie, vol. xx. p. 714. result in a dog of Luciani's, even from bilateral destruction of both temporal lobes in their entirety. * In the monkey, Ferrier and Yeo once found permanent deafness to follow destruction of the upper temporal convolution (the one just below the fissure of Sylvius in Fig. FIG. 16.-Luciani's Hearing Region. 6) on both sides. Brown and Schaefer found, on the contrary, that in several monkeys this operation failed to noticeably affect the hearing. In one animal, indeed, both entire temporal lobes were destroyed. After a week or two of depression of the mental faculties this beast recovered and became one of the brightest monkeys possible, domineering over all his mates, and admitted by all who saw him to have all his senses, including hearing, 'perfectly acute.' † Terrible recriminations have, as usual, ensued between the investigators, Ferrier denying that Brown and Schaefer's ablations were complete, ‡ Schaefer that Ferrier's monkey was really deaf.§ In this unsatisfactory condition the subject must be left, although there seems no reason to doubt that Brown and Schaefer's observation is the more important of the two. In man the temporal lobe is unquestionably the seat of the hearing function, and the superior convolution adjacent to the sylvian fissure is its most important part. The phenomena of aphasia show this. We studied motor aphasia a few pages back; we must now consider sensory aphasia. * Die Functions-Localization, etc., Dog X; see also p. 161. Brain, vol. xi. p. 10. § Ibid. p. 147. Our knowledge of this disease has had three stages: we may talk of the period of Broca, the period of Wernicke, and the period of Charcot. What Broca's discovery was we have seen. Wernicke was the first to discriminate those cases in which the patient can not even understand speech from those in which he can understand, only not talk; and to ascribe the former condition to lesion of the temporal lobe.* The condition in question is word-deafness, and the disease is auditory aphasia. The latest statistical survey of the subject is that by Dr. Allen Starr. + In the seven cases of pure word-deafness which he has collected, cases in which the patient could read, talk, and write, but not understand what was said to him, the lesion was limited to the first and second temporal convolutions in their posterior two thirds. The lesion (in right-handed, i.e. left-brained, persons) is always on the left side, like the lesion in motor aphasia. Crude hearing would not be abolished, even were the left centre for it utterly destroyed; the right centre would still provide for that. But the linguistic use of hearing appears bound up with the integrity of the left centre more or less exclusively. Here it must be that words heard enter into association with the things which they represent, on the one hand, and with the movements necessary for pronouncing them, on the other. In a large majority of Dr. Starr's fifty cases, the power either to name objects or to talk coherently was impaired. This shows that in most of us (as Wernicke said) speech must go on from auditory cues; that is, it must be that our ideas do not innervate our motor centres directly, but only after first arousing the mental sound of the words. This is the immediate stimulus to articulation; and where the possibility of this is abolished by the destruction of its usual channel in the left temporal lobe, the articulation must suffer. In the few cases in which the channel is abolished with no bad effect on speech we must suppose an idiosyncrasy. The patient must innervate his speech-organs either from the corresponding portion of the other hemisphere or directly from the centres of ideation, Der aphasische Symptomencomplex (1874). See in Fig. 11 the convolution marked WERNICKE. The Pathology of Sensory Aphasia,' 'Brain,' July, 1889. those, namely, of vision, touch, etc., without leaning on the auditory region. It is the minuter analysis of the facts in the light of such individual differences as these which constitutes Charcot's contribution towards clearing up the subject. Every namable thing, act, or relation has numerous properties, qualities, or aspects. In our minds the properties of each thing, together with its name, form an associated group. If different parts of the brain are severally concerned with the several properties, and a farther part with the hearing, and still another with the uttering, of the name, there must inevitably be brought about (through the law of association which we shall later study) such a dynamic connec tion amongst all these brain-parts that the activity of any one of them will be likely to awaken the activity of all the rest. When we are talking as we think, the ultimate process is that of utterance. If the brain-part for that be injured, speech is impossible or disorderly, even though all the other brainparts be intact: and this is just the condition of things which, on page 37, we found to be brought about by limited lesion of the left inferior frontal convolution. But back of that last act various orders of succession are possible in the associations of a talking man's ideas. The more usual order seems to be from the tactile, visual, or other properties of the things thought-about to the sound of their names, and then to the latter's utterance. But if in a certain individual the thought of the look of an object or of the look of its printed name be the process which habitually precedes articulation, then the loss of the hearing centre will pro tanto not affect that individual's speech. He will be mentally deaf, i.e. his understanding of speech will suffer, but he will not be aphasic. In this way it is possible to explain the seven cases of pure word-deafness which figure in Dr. Starr's table. If this order of association be ingrained and habitual in that individual, injury to his visual centres will make him not only word-blind, but aphasic as well. His speech will become confused in consequence of an occipital lesion. Naunyn, consequently, plotting out on a diagram of the hemisphere the 71 irreproachably reported cases of aphasia which he was able to collect, finds that the lesions concentrate themselves in three places: first, on Broca's centre; second, on Wernicke's; third, on the supra-marginal and angular gyri under which those fibres pass which connect the visual centres with the rest of the brain* (see Fig. 17. With this result Dr. Starr's analysis of purely sensory cases agrees. In a later chapter we shall again return to these differences in the effectiveness of the sensory spheres in different individuals. Meanwhile few things show more beautifully than the history of our knowledge of aphasia how the sagacity and patience of many banded workers are in time certain to analyze the darkest confusion into an orderly display. There is no centre of Speech' in the brain any more than there is a faculty of Speech in the mind. The entire brain, more or less, is at work in a man who uses language. The subjoined diagram, from Ross, shows the four parts most critically concerned, and, in the light of our text, needs no farther explanation (see Fig. 18). *Nothnagel und Naunyn: op. cit., plates. Ballet's and Bernard's works cited on p. 51 are the most accessible documents of Charcot's school. Bastian's book on the Brain as an Organ of Mind (last three chapters) is also good. |