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insanity, almost invariably render the individual incapable of managing his own affairs with any efficiency, and it would seem to be reasonable, and in conformity with the expressed opinions of physicians' in all countries, to restrain individuals thus affected, and in this way give certainty of ultimate recovery. It is also true that the fear of being deprived of liberty might act beneficially upon the individual at the time when this baneful habit is only in the process of formation. A case described by Dr. Taylor2 is somewhat interesting in this connection. But, as yet, no measure exists in this country to prevent this most pernicious habit, or to mitigate the evils which arise from its indulgence. It is in keeping with England's character as a nation of shopkeepers that the excellence of its civil laws and their administration is beyond all question-almost beyond all rivalry; while its sanitary arrangements are of the most defective nature. It is only recently that health bills have received any general attention, and even now the attention which they do receive is inefficacious to secure anything like a satisfactory settlement of questions of the most paramount importance. And yet, is it not evident that the best laws in the world are thrown away upon a nation rotten with disease, and that even bad laws would do but little harm to a nation thoroughly healthy in the widest and truest sense of the word? Look what different growths Liberty has had amongst us here, who have to struggle, and on whose foreheads the fulfilment of the curse that Adam earned is seen, and amongst those who have had elbow-room [200 in the world, and a land which brought forth abundance with but little toil. What are good laws to us if we cannot live? and if we can live, what harm can bad laws do if we live happily and healthily? Those persons who shut their eyes to the close connection which exists between disease and crime are careless observers. Those who, while they legislate for the latter ignore the existence of the former are careless legislators.

See on some of the Medico-Legal Relations of the Habit of Intemperance, by Sir Robert Christison, Edinburgh, 1861; Annual Reports of the Commissioners in Lunacy for Scotland, 1859-1870; The Social and Political Relations of Drunkenness, two lectures, by Professor Laycock; Dr. Dagonet in Journal of Mental Science for 1866, p

256.

Medical Jurisprudence, p. 1129.

CHAPTER XVIIL

APHASIA AND APHONIA.

375. The Nature of Aphasia and Aphonia.-These names are given to a disease which is manifested by a derangement or loss of the faculty of speech. There is a loss of speech which occurs while the organs of phonation are to all appearances perfect, and a confusion of speech which occurs while the intellect is unimpaired. Much controversy has taken place as to the cause of this impairment of language, and a considerable party of disputants maintain that it is due to a material lesion, while others are equally strenuous in maintaining its psychical origin. Long ago, Gall announced that the faculty of language was seated in those portions of the brain which rest on the hinder part of the superorbital plate. And quite recently, Dr. Hammond, after examining and reviewing the theories of Darx and Broca, says "that the organ of language is situated in both hemispheres, and in that part which is nourished by the middle cerebral artery;" and further, that while the more frequent occurrence of right hemiplegia, in connection with aphasia, is in great part the result of the anatomatical arrangement of the arteries which favors embolism on that side, there is strong evidence to show that the left side of the brain is more immediately connected with the faculty of speech than the right." On the other hand, Dr. Bateman has, in his able and elaborate treatise, endeavored to show that aphasia has no material centre, and that all attempts to give it anything but a psychical origiu have failed. But we in this place have

1 Discases of the Nervous System, New York, 1871, p. 202.

On Aphasia or Loss of Speech, and the Localization of Language, by Frederick Pateman, M. D., London, 1870.

scarcely to determine whether loss of speech exists without either right hemiplegia or lesion of the third left anterior convolution, or whether these lesions may exist without any effect on speech. We have really to do with the means of recognizing this disease, and one or two cases will serve to illustrate its real nature. This (2011 deprivation is sometimes general and sometimes partial. Thus, in a case mentioned by M. Broca,' the individual answered every question by means of the single monosyllable "Tan," and Sir Thomas Watson' speaks of a gentleman who misappropriated words; thus, when he wished to say "camphor," he made use of the word "pamphlet;" and Dr Bergmann has described a case in which the memory was, owing to an injury done to the head by means of a fall, affected in a peculiar way. The man forgot proper names and nouns, and at the same time he had a perfect memory of things and places, and he could pronounce correctly any verb. The case reported by Dr. J. G. Glover to the Clinical Society of London in 1871 is also curious. There the patient was without any trace of cerebral disease, with no hemiplegia, with no difference in sensation of the two sides, with ability to walk, write, and to protrude the tongue straight; was yet unable, when shown a familiar object, to recall the proper name for it, but would designate a book before him as "good," "horse," "butter;" called a watch tempus fugit, though able to write the word watch correctly. A similar perversion of words pervaded his whole range of vocal expression. Many other cases might be quoted to show in what way the morbid conditions of the brain manifest themselves. However, it is not our duty in this place to do more than indicate the existence of such a morbid mental condition, and to point out in what way it may be recognized, and how its existence, when proved, must modify the legal relations of the individual in whom it occurs. This is not a place for the consideration of the inter

Sur le Si ́ge de la Facult' du Langage Articule.
Practice of Physic, vol. ii., p. 511.

3 Einige Bemerkungen uber Störungen des Gedachtriess und der Allgemeine Zeitschrift fur Psychiatrie, 1849, s. 657.

Some of the most interesting of these will be found in a paper on Impairment of Language, in vol. ii. of the West Riding Asylum Medical Reports, by Dr. W. A. F. Browne.

4

esting questions with regard to cerebral pathology which have arisen in connection with this subject, or to trace the curious confirmation which has been given by the modern physiologists, some of the ablest of whom have [262] ascribed aphasia to a lesion in the posterior part of the third frontal convolution of the left hemisphere, to the theories of phrenologists. A comparison of Dr. Bateman's papers upon aphasia with some of those contained in the Phrenological Journal' will prove this interesting fact. There can, however, be no doubt of the existence of this very curious phenomenon, and it is manifested in various ways. Dr. Falret has made the following classification of some sixty-two cases which he has collected from various authors. 1. All those cases in which the patients, whilst retaining intelligence and integrity of the organs of phonation, can only remember or articulate certain words or classes of words, or even certain syllables or letters, but who can repeat and write any word that may be suggested to them by others. 2. Those who are only able to pronounce spontaneously certain words, syllables, or phrases always the same, not being able to repeat other words dictated to them, and who yet retain the power of writing or even reading. 3. Those more rare cases in which the patients can only pronounce certain words always the same, which, aided by gesture, enable them to express their thoughts, the power of reading, writing, and repeating words being abolished. M. Broca mentions a very interesting case falling under the last of these three class descriptions. The individual who in this case suffered from aphasia, used four words, and attached a definite meaning to each of these four. The words saved out of the wreck of a vocabulary were "oui, non, tois, (for trois,) and toujours." When he wished to affirm, he used the first; when he wished to negate, he used the second. By the third, he expressed all ideas of number, but he was conscious that it did not convey all his meaning, for

1 See Memoir by Professor Saunders on Aphasia, Edin. Med. Journal, vol. xi., pp. 811 and 1042.

* See Journal of Mental Science, vol. xiii,, p. 521, vol. xiv., pp. 50, 345, 489. See also Trousseau's Clinique Medicale, tom. ii.

3 See vol. iii., pp. 26, 616, etc.

Des Troubles du Langage, p. 5.

when he wished to show that the number meant was more than three, he held up his fingers. This gesture was an accurate indication of the state of the case. Whenever none of the three first words would do, he used the fourth, toujours, which, as may be understood, had no very definite connotation.'

? 376. Necessity for Considering the Legal Relations of Aphasics. Now, these cases and many more of equal interest, which will be found quoted and narrated in the works already referred to, indicate the necessity of the recognition of this 263 disease by those persons who devote themselves to medical jurisprudence. If a man loses the faculty of speech, if he substitutes one word for another, if he says "No" when he wishes and means to say "Yes," if he has a vocabulary limited to four words, and at the same time is in possession of all his intellectual faculties, it is surely evident that he cannot occupy the same relation to his fellow-men that those persons do who are possessed of a sufficient vocabulary to carry them through life with its ordinary business transactions; and it is surely clear that, just as there are peculiar provisions for those who cannot write, so ought there to be some provisions for those who cannot speak. The four or five words of the man mentioned by Broca are very much in the same relation to his intelligence that an illiterate person's mark is to his.

377. The Capacity of Aphasics.-Most of the people who are dumb are dumb only because they are deaf, and the law, upon account of the impossibility of their acquiring any adequate knowledge, has looked upon them as idiots, but it is a very different matter where speech has been lost owing to some bodily disease or local injury. In these cases education has raised the individual to the ordinary level, and the mere obliteration of a piece of local memory, of a portion of a vocabulary, or the loss of power to concatenate the exact sound with its appropriate idea, does not deprive the individual of all the power to do many things as well as he did them formerly.

See another case, Phrenological Journal, vol. xii.,

p. 155.

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