APHASIA 
BY 
A. D. ROCKWELL, M. D.. 
NEWYORK; 
Electeo-Thekapeutist to the Woman’s Hospital of the 
State of Hew Yoke. 
From the Chicago Journal of Nervous and Mental Disease, 
January, 1875. 
CHICAGO: 
Printed by J, J. Spalding & Co. 
1875. APHASIA. 
T3PIAIMINAR.Y to a few practical considerations concern- 
ing aphasic symptoms, I call attention to the following 
cases which serve as texts for all that I have to otter; 
By invitation of Dr. E. R. Peaslee, I saw in December, 1873, 
a Mr. A., a gentleman somewhat advanced in years, and who 
was suffering from right hemiplegia with complete aphasia. 
About a year previously he was taken with left hemiplegia, 
but there wras no accompanying aphasia; his speech was quite 
clear, and he rapidly progressed toward almost complete 
recovery. 
Two months prior to the date when the patient fell under 
my observation, paralysis of the right side suddenly super- 
vened, associated, as I have already remarked, with aphasia. 
The intellect remained measurably quick and clear, but 
da da was the only utterance that the patient would attempt. 
When he essayed to write, the result of his efforts were mani- 
fested only in a meaningless combination of letters. 
The diagnosis was: Lesion of the anterior lobe of the brain, 
probably the third frontal convolution, and the prognosis de- 
cidedly unfavorable, if not absolutely discouraging. Treat- 
ment by the galvanic current, which was for a short time car- 
ried on at the earnest solicitation of friends, resulted in no 
benefit. 
I was consulted December 7, 1873, by a lawyer aged fifty- 
three. One morning, some eight months prior, he arose in his usual health and for some hours attended closely in his 
office to a press of business that had accumulated during a few 
days’ absence from the city. While thus engaged he observed 
that his right leg was a little numb, and that there was a disa- 
greeable-sensation of tingling in the fingers of the right hand. 
Almost immediately he felt that his whole right side was par- 
alyzed, and, on attempting to speak he found that he could not 
co-ordinate intelligible expressions. In a few days the patient 
regained almost the normal power over the paralyzed members, 
but his speech returned more slowly, and for three months 
before I saw him there had been little perceptible progress. 
He could speak shori, disconnected sentences well enough, 
but when he attempted to engage in animated conversation, he 
not only constantly used words that utterly failed to convey 
his ideas, but frequently all remembrance and power of ex- 
pression seemed to forsake him, so that he was unable to pro- 
ceed until reminded of the proper word and the thought that 
he had been expressing. The patient was treated for about a 
month by central galvanization, and with very marked benefit. 
The improvement in speech, which had ceased for three 
months, became again manifest, so that in a few weeks he 
could converse with much greater readiness. To this day, 
however, considerable difficulty in co-ordinating words and 
ideas remains. 
I refer lastly to a poor man who became aphasic during con- 
valescence from a severe attack of typhoid fever. 
This patient, while working as a common laborer in the city 
of Pittsburg, was prostrated in October, 1873, and was at once 
removed to a hospital. 
During the first two or three weeks of a rather tedious con- 
valescence, no change in the character of his speech was ob- 
served, but shortly before his discharge, and while feeling that 
strength was surely returning, he noticed a slight impairment 
of the co-ordinating power of expression, which day by day 
increased in degree until he lost almost completely the power 
of intelligible converse. 
He came to Hew York in February, and on the 21st of 
March he was sent to my office. At this time he had been 
aphasic for ten weeks, with no symptoms of improvement. 5 
The patient was anaemic, there was decided oedema of the 
mwer extremities, and the heart’s action was violently irregu- 
lar, although this was not due to any organic cardiac disease. 
On general principles I submitted him to general faradiza- 
tion daily. The immediate results of this treatment, i. e., 
those that followed within a week, were an increased flow of 
urine, disappearance of the oedema, and increased regularity 
of the heart’s action. He began to improve in his speech at 
the end of the second wTeek of treatment, and in two weeks 
more he was able to converse with his usual fluency. 
These three cases seem to me to be of interest as illustrat- 
ing a number, although not all, of the various forms under 
which aphasia may manifest itself. In the first case both the 
paralysis and aphasia were complete and persistent. From the 
beginning there had been no change for the better, and the 
future offered no hope of even a partial recovery. It will be 
observed on referring to the case that the patient had suffered 
from two attacks. In the first instance the left side was 
affected, but, as is almost always the case, the paralysis was 
accompanied by no aphasia. The second attack was on the 
right side, and associated with complete aphasia. 
These facts serve to recall the excited and interesting dis- 
cussions that have arisen relative to the localization of the 
faculty of speech. In 1865 the subject was exhaustively con- 
sidered by the Academy of Medicine of Paris, and although 
the discussion neither resulted in any general settled conviction 
in regard to the localization of the faculty of speech, nor satis- 
factorily decided the question whether any particular portion 
of the brain was the invariable seat of hemiplegia with aphasic 
symptoms, it yet served to throw much light on several dis- 
puted points, and to lead to a more correct appreciation of the 
therapeutical indications. 
From the facts elicited at these discussions it was rendered 
evident that complete and persistent hemiplegia, associated with 
grave aphasic symptoms, similar to the case first detailed, de- 
pend on deep-seated and destructive organic lesion, situated, 
as a rule, in the third left frontal convolution of the cerebrum, 
or in its immediate neighborhood, and is not amenable to any 
form of treatment. Electricity, except so far as it may aid 6 
nutrition in the affected limbs, is in such a case useless. Be- 
tween such hopeless seizures as the above, and mild transitory 
aphasic symptoms without paralysis, there are manifestations 
of aphasia of various grades of severity. 
Slight disturbances of speech unattended by paralysis disap- 
pear rapidly and without treatment, and if, as it is possible, a 
local change in the structure of the brain takes place, it com- 
prises nothing more than some slight molecular disturbance. 
Following a somewhat graver and more deeply-seated central 
lesion, we have aphasia associated with paralysis, more or less 
persistent, but amenable to a greater or less extent to rest and 
treatment. 
The second case is a fair illustration of such an attack, of the 
somewhat transitory character of the attendant paralysis, the 
greater persistency of the aphasia, and the benefit to this 
symptom that may accrue from treatment. Aphasia following 
convalescence from fever is illustrated in the last case. In the 
graver forms of aphasic hemiplegia, we clearly understand that 
there exist deep-seated and destructive lesions, and even in 
the milder forms we know that actual structural change or 
congestion is to some degree present. In aphasia following 
fevers, however, congestion as a cause is hardly possible, if we 
take into consideration the character of the onset and the at- 
tendant symptoms, and it is on the whole difficult to conceive 
of the nature of the lesion. 
In 1820, Lordat, of Paris (who some years subsequently be- 
came aphasic), wras the first to apprehend the true character of 
the affection, viz.: that it was due to a loss of the power of 
co-ordination, and not to actual paralysis of the tongue or muscles 
of the face. Bouillaud went a step farther, and located the fac- 
ulty of speech in the frontal lobes. Subsequently, Dr. Marc 
Dax, in a paper entitled, “ Lesions of the Left Half of the Brain 
Coinciding with the Loss of Memory of the Signs of Thought,” 
asserted that the faculty of articulate language was exclusively 
located in the left hemisphere of the brain. He had never seen 
a case of left hemiplegia with aphasia. 
Trousseau, in a most extensive hospital experience, met with 
but one case of left hemiplegia associated with aphasic symp- 
toms, and which at that time he asserted to be the only one 7 
recorded. Finally M. Broca located the faculty of articulate 
language in the third left frontal convolution, and claimed that 
organic disease of this special portion of the brain must neces- 
sarily be accompanied by aphasia. Now in regard to the ideas 
enunciated by the above investigators, it must be admitted that 
(with the exception of Lordat) they are but partial truths. 
That this affection which he termed “ alalia ” is due to an 
impairment of the power of co-ordination, and not to muscular 
paralysis, has never been doubted. 
The conjecture of Bouillaud that the faculty of articulate 
language has its seat in the frontal lobes of the brain, of Dr. 
Marc Dax, that it is located in the left hemisphere of the brain, 
of Dr. Gr. Dax, the son, that not only is its invariable seat in the 
left hemisphere, but, more minutely, that the outer portion of the 
middle lobe is its true location, and, finally, the opinion of M. 
Broca that the posterior portion of the third left frontal convo- 
lution is the seat of the faculty of speech-all these conjectures 
are only so many steps to a clearer appreciation of the truth. 
So far as can be ascertained from physiological and pathological 
investigations, and from the records of clinical experience, it 
seems evident that no one minute portion of the brain can yet 
be claimed as the exclusive seat of the faculty of language, or 
of organic lesion in hemiplegia with aphasia. The truth briefly 
stated would appear to be this : Ist, Aphasia is as a rule, the 
result of injury to the frontal lobes ; 2d, the left hemisphere is 
almost universally the seat of lesion ; 3d, the posterior portion 
of the third left convolution is the most frequent seat of struct- 
ural change. 
The experiments of Fritsch, Hitzig and Ferrier, although 
yet of but little practical value to electro-therapeutics, have at 
least cleared up somewhat the pathology of aphasia. They 
not only show that the portion of the brain which presides 
over the faculty of the memory of words governs also the 
movements of articulation, but conclusively confirm the theory 
that in every essential point the brain is symmetrical. Its 
action is generally unilateral and crossed, but it is most signifi- 
cant that so far as it controls the movements of the mouth, its 
action is bilateral, which accounts for the fact that a one-sided 
cerebral lesion is not followed by paralysis of the muscles of 8 
articulation. The opposite side of the brain performs the work 
of its fellow. How, then, it may be asked, can we explain 
the well-recognized fact that loss of the power of 
speech is universally associated with left cerebral lesion ? In 
all probability it is due to this:—that as most people are right- 
handed so are they left-brained ; and yijesion of the left hemi- 
sphere with aphasic symptoms, the memory of words is not 
totally destroyed, since the seat of this faculty is in the right 
side also, but the victim is without the power of articulate 
speech because the right side of the brain has been so little 
exercised as to be incapable of acting alone. 
This theory helps to explain the occasional recoveries of 
speech in aphasia resulting from undoubted and serious lesion 
of the left hemisphere. The right side of the brain is educated 
in the same way that the left hand is educated when its fellow 
becomes disabled.