On aphasia : or loss of speech, and the localisation of the faculty of articulate language

Front matter

fyxmW Wimvmiiii^ J

ME

FUND

Preface

Perhaps there is no subject in the whole range of neuro-pathology that has engrossed so large a share of the attention, not only of the medical profession, but of scientific men generally, in all parts of the world, as the Localisation of Speech, and the causes which interfere with the outward manifestation of that faculty.

My first edition, published just twenty years ago, was one of the earliest, if not the very first treatise on Aphasia that appeared in this country ; and the favourable reception accorded to it both at home and abroad, might justly have encouraged me to issue a second edition long ago. I was deterred, however, from a hasty reproduction of the work, by the great diversity of opinion prevalent upon the points at issue, and I have preferred to wait till the horizon of scientific controversy was somewhat cleared, and the tangled skein of medical psychology partly unravelled.

In the arrangement of my subject, I have followed very much the plan of the first edition, beginning with a condensed bibliographical sketch of the contributions of British, American, and continental writers. As the literature of aphasia has become so immensely enriched

PREFACE.

during the last twenty years, it may possibly be thought that a Bibliography was an anachronism ; I have, however, decided to retain that portion of the work, as I have reason to believe that it has been useful to other writers, more especially as many of the cases referred to, are contained in works not easily accessible to the majority of my readers.

The present edition is not merely a reprint of the old one, with a few casual alterations ; I have endeavoured to bring the work up to the present state of our knowledge of the subject of which it treats, and I have added so much new matter as to constitute it rather a new work than a revised edition of a former one. Amongst the fresh matter added, I may refer to the chapter on the Jurisprudence of Aphasia, a subject of paramount importance to the medical jurist, and which, as far as I know, has not been treated by any British writer. In the concluding chapter certain collateral subjects, only indirectly connected with the localisation of speech, are considered, such as the Minute Anatomy, the Histology, and the Chemistry of the Brain.

One word as to the title of the book. As I have treated of all disorders of the expression and of the comprehension of the signs by which man can express his thought, I might, perhaps, have selected a more comprehensive term than that which I have adopted ; rather, however, than invent a new word, I prefer to retain the word Aphasia, subject to the above explanation.

When I first wrote upon this subject twenty years ago, the question of the localisation of cerebral function was

PREFACE.

in its infancy, and our knowledge of the actual pathological changes occurring in nerve tissue were vague and unsatisfactory. Although an immense stride has been made during the last few years in neuro-pathology, we seem still to be to some extent on the threshold of the inquiry ; and the difference of opinion between the most eminent authorities upon the points in dispute is so great, that much is still to be learnt, before we can speak with anything like mathematical precision, of certain functions of that wonderful piece of mechanism — the human brain. Indeed, when I consider the large amount of research that has been expended upon this subject, and contrast it with the precise knowledge that we possess, I am inclined to say with Goethe : —

In the preparation of this treatise, I have been much indebted to the kind co-operation of other labourers in the same department of science, both at home and abroad; and amongst those to whom my especial acknowledgments are due, I may mention Drs. Gowers, Bastian, and de Watteville of London; Professors Struthers and Hamilton, of Aberdeen ; Professors Ball of Paris, Goltz of Strassburg, and Benedikt of Vienna.

FREDERIC BATEMAN.

Norwich, May, 1890.

Chapter I. Page

Definition. Bibliography — Hippocrates; Sauvages. Description of the disposition and arrangement of the cerebral convolutions. Writers of the French school — Bouillaud ; Andral ; Drs. M. and G. Dax ; Professor Broca, his 7ie plus ultra of pathological topography, summary of his two primitive and typical cases; classification of Jules Falret; clinical lectures of Professor Trousseau. The celebrated discussion on the localisation of the faculty of speech, at the Academy of Medicine of Paris ; M. Bouillaud's challenge ; the test case of M. Velpeau ; divers observations from the French press. Ladame's statistics of lesions of speech in connection with tumours of the brain. Description of Professor Charcot's diagram of the mechanism of articulate and written language 13

Chapter II

Bibliography continued. Schrceder van der Kolk — his theory of the connection of speech with the olivary bodies, which he regarded as auxiliary ganglia to the hypoglossus nerve ; his argument from Comparative Anatomy ; a case in support of his views; testimony of Cruveilhier. German writers — Romberg ; Bergmann ; Hasbach ; Von Benedikt and Braunwart; Kussmaul - 4^

CONTENTS.

Chapter III. Page

Bibliography continued. English, Scotch, and Irish writersdiscussion at the annual meeting of the British Medical Association at Dublin, in 1867 ; aphasia occurring as a com plication of cerebro-spinal arachnitis. American contributions to the literature of aphasia — S. Jackson, Hun, Bigelow ; Wilbur on defects of speech in idiots ; Austin Flint ; Seguin, his statistics of the p£trts of the encephalon damaged in 556 cases of aphasia; Hammond, his views on the question of the localisation of speech ; divers communications to the American journals 5^

Chapter IV

Author's own clinical experience — Volumetric analysis of the urine in cerebral disease. Aphasia of the ataxic form occurring as the earliest indication of disease ; curious chain of morbid symptoms, eventually merging into general paralysis ; critical analysis of the clinical history ; autopsy ; question of the testamentary capacity of the patient. Three cases of aphasia in which the autopsy revealed a healthy condition of the frontal convolutions ; importance of examining the condition of the bones of the cranium in aphasia, as illustrated by these cases. Loss of speech with paraplegia ; spinal symptoms. Aphasia as a climacteric symptom. Loss of speech with left hemiplegia ; extensive cardiac disease, frontal convolutions healthy, fibrinous blocks in the spleen. Loss of speech, preceded by numbness of the tongue; lingual spasm, eventually ending in bulbar paralysis. Case of puerperal aphasia ; lacteal derangement, galactorrhsea from vaso-motor paralysis.

Intermittent aphasia ; epileptic logoneurosis ; peculiar form of aura ; the epileptogenous zone being always in the neighbourhood of the cervical sympathetic; complete suspension of articulate language for six weeks, without any motor paralysis, and with the general faculty of language unimpaired ; patient

PAGE

able to communicate with others by writing, and also by dactylology. Good efifects of electricity; critical analysis of the exceptional symptoms manifested by this patient. Inquiry as to what part of the complicated mechanism of speech the psychical condition could be pathogenetically referred. Views of Gowers, Trousseau, Kussmaul, and Ball on similar cases. Spasmodic ischsemia gS

Chapter V

Synonyms. Definition of aphasia. What is Speech ? Analysis of the faculty of Language — Max MuUer; Kussmaul; Whitney; Ross; Cerise; Parchappe. Speech is a physico-psychical act ; consists of two distinct elements, one somatic — • a movement, the other psychical, the interior speech — the Koyos ; the impressive or ingoing, and the expressive or outgoing functions of language. Articulate Language is a Universal attribute of Man — testimony of Dr. Moffatt, Sir Bartle Frere, and Sir Samuel Baker ; the homo mutus of Lord Monboddo.

The organs of voice, the accoustics of speech, and the mechanism of articulation ; the larynx a musical instrument of extraordinary perfection ; . the tongue not essential to speech. Articulate language must not be confounded with the General faculty of language. On the language of Nature in contradistinction to acquired or artificial language or Speech — the Natural language of the Voice, of the Physiognomy, and of Gesture; illustrations from Euripides, Cicero, Shakespeare, and Corneille.

Eulogy of gesture-language by Vossius, who preferred it to articulate speech ; serves as the habitual means of commimication with the Cistercian and Carthusian monks; illustrations of the advantage of this form of language, from Lucian, CElianus and Macrobius. The transition from natural to artificial language exemplified. Speech an acquired reflex. Kussmaul's comparison of the speech mechanism to a telegraphic apparatus. 149

CONTENTS.

Chapter VI

Classification. Discussion at the British Association at Norwich in 1868. Professor Charcot on the passive and active phases of the faculty of language. Dr. Bastian on the auditory, visual, and kinjesthetic memories. Varieties — Aphasia may be complete or partial, permanent or intermittent. Is sometimes limited to substances; sometimes to proper names — ^Thucydides, Pliny, Vauvenargues. Baron Larrey's celebrated case of gun-shot wound. The defect may be limited to a particular language ; on one occasion a knowledge of Greek only was lost. Languages revived during delirmm.

Recurring utterances, stereotyped phrases from " fossilisation " of impressions. May be the sole morbid symptom — Professor Rostan's personal experience ; typical case obseiyed by the author. Heterophasia or Paraphasia — the inability to connect word-images with their corresponding conceptions. The Spectator on perversion of speech, with an analysis of the author's first edition. Can thought exist without word-images ? A case of verbal delirium. Agraphia, or loss of the faculty of written language — a defect in the cheiro-kinsesthetic centre ; is not a material but a psychical inability to write.

On Mirror-writing (Spiegelschrift), or the reversal of the normal position of the letters ; BouoTpo^iySoi/ mode of writing. Greek Epigraphy — Welsford, Roberts. Paramimia, or the perveirsion of pantomimic language; remarkable echo case observed by the author at La Salpetrifere — a human parrot : an acoustic reflex. The language of Physiognomy. - 178

Chapter VII

Varieties of aphasia continued. Sensory Aphasia — the impressive or centripetal function essentially impaired. The psychology of hearing, and the cerebral operations that follow impressions on the ear. Word-deafness — a purely psychical,

PAGE

and not an auditory defect ; may be confounded with insanity. The perception of musical sounds may be abolished as well as that of articulate language— Grant Allen on Note-deafness.

On verbal amnesia. The psychology of sight, and the cerebral operations that follow impressions on the eye. Word-blindness — a psychical and not a visual defect; illustrations from Charcot and Ross. Pathology of Word-deafness and Word-blindness. The auditory and visual centres in the brain ; experiments on animals by Ferrier, Schafer and Sanger Brown ; their conflicting results. Hemianopsia — -Gowers on the higher visual centre ; Chauffard, Pfliiger, Skworzoff, and de Watteville. Intermittent Aphasia — functional cerebral ischaemia. Automatic utterances under emotion — the interjectional expressions of aphasics. Hysterical mutism — essentially of a dynamic nature ; can be produced artificially by hypnotism. 216

Chapter VIII

Etiology of Aphasia — May be congenital. Deaf-mutism — ■ Kussmaul's statistics as to sex, locality, &c. ; the dumbness not due to the absence of the faculty of speech, but to its want of development. The loquelar defect in Idiots — ^Esquirol's classification of idiocy ; Kerlin's statistics ; the aphasia of the idiot not to be confounded with deaf-mutism ; intemperance of the parents as a factor in idiocy ; the tardy development of speech from intra-cranial lesion. Aphasia may be the result of exostosis of the cranial bones ; of thrombus of the cerebral arteries ; of ischsemic softening ; of tumours or abscess in the brain, &c. Huguenin on loss of speech in tuberculous meningitis. Macewen on the Surgery of the Brain. Gowers on irritative inhibition. Traumatic Aphasia caused by direct injury to the brain— Baron Larrey, Simon, &c. ; three cases observed by the author. The role of the sympathetic system in the production of aphasia by vaso-motor paralysis. Loss of speech may occur as a remote symptom of endopericarditis, of spinal

PAGE

disease, and also as the result of emotional excitement. Neurokinesis. May be caused by atmospheric changes ; by reflex action ; by the bite of venomous snakes ; by the action of certain drugs ; by the excessive use of tobacco ; by simple molecular disturbance of the brain cells. Hephsestic hemiplegia. Puerperal aphasia — cerebral ischsemia. 245

Chapter IX

Diagnosis — Aphonia; whispering is in reality an articulate language. Labio-glosso-pharyngeal paralysis. The speechlessness of lunatics. Importance of the quantitative analysis of the urine — ursemic poisoning, renal inadequacy. The Sphygmograph and the Ophthalmoscope. Thermometric observation and its value in cerebral pathology ; thermic exploration of the different cranial regions — Broca, Voisin, Lombard, and Maragliani. Auscultation of the parietes of the cranium.

Prognosis — more favourable in traumatic cases, and when uncomplicated with any paralytic symptom. Professor Benedikt's case of tardy development of speech in congenital aphasia. Recovery of speech after suspension of the faculty for twenty years.

Treatment — must depend upon the cause which produces it. Electricity ; its indiscriminate use to be . deprecated ; views of Todd, Marcet, and Radcliffe. Influence of sudden mental shock in rousing the dormant faculty of articulate language — Herodotus, Wiedemeister, Ireland. Trephining in traumatic aphasia ; report of three successful cases at the Royal Academy of Medicine of Ireland. On the re-education of the nervous centres - - * - . 279

Chapter X

On the Jurisprudence of Aphasia — French and German writers on the subject; not hitherto treated by any British author. Loss of Speech may affect both civil and criminal responsibility. The testamentary capacity of aphasics — a speechless Mayor ; the validity of wills made by the deaf and dumb ; probate granted of the will of a deaf and dumb testator, whose wife was also a deaf-mute, and who, with other deaf and dumb witnesses, gave evidence at the trial. Remarkable case

a testator disposing of a large fortune by means of gesture language; probate of the will being refused solely on the ground of a slight technical formality.

On the capacity of speechless persons to manage their affairs generally ; important case submitted to the Medico- Legal Society of Paris. The " interdiction " of the French code. The medico-legal aspect of the author's own cases recorded in this treatise, in which the symptoms were due to injury of the expressive mechanism of speech. Word-blindness and Word-deafness, being disorders of the impressive mechanism of speech, may throw doubts upon testamentary capacity, and the study of this form of Sensory Aphasia is of capital importance to the medical jurist.

Inability to speak will not absolve a person from civil and criminal responsibility, and deaf-mutes are held responsible for their acts; a marriage in which the bridegroom, bride, and bridesmaids were all deaf-mutes, the ceremony being performed in the deaf and dumb alphabet. A cause decided solely on the evidence of three dumb witnesses. Articulate language is not the only medium of thought and of expression; — the outward sign may be verbal, vocal, graphic, or mimic. A presidential address delivered entirely in gesture language. Aphasia does not necessarily entail testamentary incompetency, or inability to discharge civil or social functions.

Chapter XI

Summary— The Psychology of the ancients; their crude notions of the functions of the brain ; Hippocrates, Aristotle, Servetus, Lapeyronie, Willis, and Huarte. The different theories as to the seat of speech ; Gall, the pioneer of cerebral lO CONTENTS.

PAGE

localisation ; his system of Phrenology based on the external prominences of the skull — cranioscopy ; the value of his researches. The connection between Matter and Mind. A faculty should not be confounded with the corporeal organ upon which its external manifestation depends. The various theories of the localisation of the faculty of articulate language considered, and weighed by the evidence contained in the preceding chapters. Dr. Allen Starr on diseases of the Pons. The brain not the sole organ of the mind.

On Hypnotism — its two stages ; desirability of studying hypnotic phenomena; views of Ballet, Bernheim, and Hack Tuke ; the Salpetrifere experiments and their' bearing on the speech question. The decussation of the optic fibres — Grasset, Michael Foster ; views of Hamilton, Ross, and Gowers as to their ultimate course. Views of non-medical writers as to the seat of speech — H. Spenser, G. J. Romanes. Discussion on cerebral localisation at the Washington Medical Congress. The brain compared to a violin. Brown-S^quard on Inhibition as a factor in aphasia. 315

Chapter XII

Consideration of certain collateral subjects indirectly connected with the Localisation of Speech. The minute Anatomy of the brain. The symmetry of the two hemispheres ; views of Todd and Broca; statistics of Lebon. Craniological studies on the skulls of lunatics. Cerebral asymmetry and its relation to criminality ; the reduplication of the second frontal convolution said to be common in murderers — a statement supported by Benedikt and Bouchard.

The science of Criminal Anthropology — its literature ; Enrico Ferri on the factors of crime. Professor Lombroso's description of the habitual homicide ; Manouvrier on the presence of the metopic suture; his researches in the Paris catacombs. Gradenigo on the hearing of criminals; Osier on criminal automata. On psychical anaesthesia ; the peculiar phraseology of the Criminal Anthropologists. The comparative weight of the two hemispheres — statistics of Boyd, Luys, and others.

The brain from an anthropological point of view ; weight of the brains of eminent men. Minute structure of the cerebral convolutions. Mierzejewski on the brains of Idiots. Broadbent's researches on the peculiar structure of the third frontal convolution ; great development of this gyrus said to exist in orators; description of the brain of Gambetta. The Paris society for mutual autopsy.

Physiology — considerations on left-handed aphasics ; a left-handed family. Ligature of the left common carotid, and its effect on speech. On dextral pre-eminence ; why is the human race right-handed? Views of Bichat and Ferrier. Aristotle on the preferential use of the right limbs in animals ; dextral pre-eminence observed in monkeys ; the left-handedness of the ancient Hebrews. Embryology — Gratiolet's theory of the early development of the frontal convolutions, denied by Carl Vogt.

Comparative Anatomy — Is language the exclusive prerogative of man ? Leconte and Waterhouse on the gesture language of the ape tribe. The emotional language of certain animals. The mimicry of the parrot merely an acoustic reflex. Articulate speech furnishes the difference of kind between man and animals which Darwin asserted did not exist. Physiological homologies between the brain of man and that of the ape. Carl Vogt on the comparative development of the third frontal convolution in man and in the ape — why man speaks and the ape does not. The frontal convolutions of the microcephali The island of Reil an important characteristic of the humar brain.

Experimental Pathology — Bouillaud's experiments on thi brain of animals. Researches of Hitzig, Ferrier, and Buret Goltz on the croaking of the frog. On the afifinities and differences between the brain of man and that of animals — th( bridging convolutions ; the hippocampus minor.

General Anthropology — The comparative facility of speed

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in the different races of mankind. Gratiolet's three divisions of the human species. The collection of ancient skulls of the Abbd Frfere at Paris. The cranial researches of Barnard Davis, Broca, and Flower. Has the cranial capacity of the population been increasing in proportion to the progress of civilisation ? Latin writers on the progressive deterioration of the human family. The recent controversy on the diminution of the average size of heads, as illustrated by the change in the size of hats. Herodotus on the influence of head coverings on the thickness of the skull ; his description of Persian and Egyptian skulls. Skulls of the Egyptian mummies. Broca's comparison between the heads of twenty-four medical students and the heads of twenty-four ward attendants. Importance of anthropology to the student of the science of language.

What do we understand by the expression "Faculty of Speech ? " Does the loss of this faculty necessarily imply organic lesion of structure ? Richardson's experiments of freezing the cerebrum of animals — refrigerated frogs. Experiments on pigeons — the " Potentiality of Vitality." Action of chloroform on nerve tissue. Each brain cell a minute voltaic battery. Cerebral Thermometry — -the temperature within the cranium compared with that of the scalp. Pernicious Anaemia — Bristowe, Leven, and Seppilli on hypoglobulia or diminution of the number of the red blood corpuscles.

On the Chemistry of the Brain —Thudicum on the phosphorised principles and the cerebromides. Is the variation in conversational power dependent on the chemical composition of the brain ? The phosphorus theory considered — the supposed connection between the amount of phosphorus in the brain and intellectual vigour ; views^ of Moleschott and Couerbe ; the influence of intellectual activity upon the elimination of phosphoric acid in the urine. Concluding remarks. 359

ON

APHASIA,

OR

AND

The Localisation of the Faculty of Articulate Language.

BY

FREDERIC BATEMAN, M.D.,

Fellow of the Royal College of Physicians.

Senior Physician to the Norfolk and Norwich Hospital ;

Corresponding Member of the Academy of Medicine of Paris^ and of the

Psychiatrical Society of St. Petersburg ;

Hon. Member of the New York Neurological Society ;

Foreign Associate of the Medico-Psychological Society of Paris ;

Hon, Physician to the Norwich Asylum; Visiting Physician to the Bethel Hospital ;

Consulting Physician to the Lind Infirmary for Children^

the Norwich Eye Infirrnary^

and the Eastern Counties' Asylum for Idiots.

SECOND EDITION, GREATLY ENLARGED.

LONDON :

J. & A. CHURCHILLj

X

COBiMELL \U8RARVy

APHASIA,

OR

%0S3 of Mp6liC%

AND

The Localisation of the Faculty of Articulate Language.

Chapter I

Definition. Bibliography. Hippocrates ; Sauvages. Description of the disposition and- arrangement of the cerebral convolutions. Writers of the French School — Bouillaud ; Andral ; Drs. M. and G. Dax ; Professor Broca, his >ie plus ultra of pathological topography, summary of his two primitive and typical cases ; Jules Falret ; Trousseau. The celebrated discussion at the Academy of Medicine of Paris ; case of M. Velpeau's barber; divers observations from the French press. Description of Professor Charcot's diagram of articulate and written Language.

]_Aphasia is the term which has recently been given to the loss of the faculty of language, and of the power of giving expression to thought, the organs of phonation and of articulation, as well as the intelligence being unimpairedTi The pathology of this affection has been for several years past, and is still, the subject of much discussion in the scientific world ; although only a symptom common to several morbid conditions, it has found a place in all systematic treatises on diseases of the nervous system ; the Academy of Medicine of Paris

B devoted several of its stances during the year 1865 to its special elucidation, and the medical journals of our own country, as well as those of P' ranee, Germany, and America, have lately contained a good deal of original matter bearing upon this obscure feature in cerebral pathology.

In a brief communication to the " Lancet " for May 20, 1865, I drew attention to the then existing state of our knowledge of the pathology of aphasia, this essay being, I believe, one of the earliest notices of this subject published in this country ; since that period I have had occasion to make researches among various British and foreign authors, and having noticed a certain number of curious observations tending to illustrate the various theories in connection with loss or lesion of the faculty of speech, I have thought it not a useless task to give a riszim^ o{ the labours of scientific observers in various parts of the world, who are endeavouring to elucidate this complex question, adding thereunto the result of my own personal experience, the clinical history of my own cases being given with a considerable amount of minute detail.

It is my intention in the following treatise to consider the subject from a wider point of view than that adopted by previous writers ; I propose to study the physical and psychical nature of the loss or perversion of language both natural and artificial, and I shall embrace all degrees of impairment of speech, both as regards language itself or its power of expression. I prefer, therefore, to

use the word aphasia in its strictly etymological sense

a ^aaia — and I would thus apply it to all cases where speech is abolished or suppressed for whatsoever cause, believing that is more convenient for the purposes of

HIPPOCRATES ; SAUVAGES. 15

pathological research, thus to consider lesion of speech in its general and widest sense. The various prevalent physiological theories will be discussed, and I shall also enter into the domain of facts, and ask of clinical observation a solution of the difficulties with which my subject is surrounded.

From time immemorial, loss of speech, unconnected with any other paralytic symptom, must have been noticed, but it is only of late that the diagnostic value of this symptom has been recognised, and its pathology attempted to be explained ; and it is probable, moreover, that early observers may have confounded paralysis of the tongue from disease of the hypoglossus, with that loss of the memory of words, and inability to give expression to the thoughts which characterise aphasia.

It has been stated that Hippocrates confounded aphasia with aphonia ; I am inclined, however, to think that the reputation of the Father of Medicine has suffered from the fault of his English translator, for in his " Epidemics "* he describes a disease characterised by sore throat and hoarseness of voice, using the phrase

"iroXXol cjiapvyyas i'7r6vr]crau (pmval KaKoifievai," the last twO WOrds

of which have been erroneously rendered in English " loss of speech !" In another place, Hippocrates clearly distinguishes between loss of speech and loss of voice, by employing the words " avauSoj " and "at/xuras" in the description of the same case.

The following passage from Sauvages shows that the distinction was clearly understood by him: "Aphonia est plenaria vocis suppressio. Mutitas (quibusdam

* Hippoc. "de Morb. Pop.," lib. iii., sec. ii., p. 80, edit. Innys.

For the better understanding of the subject, it seems desirable to enter into a few anatomical details, and as the minute anatomy of the surface of the brain has not to my knowledge been so elaborately described by any English author, as by the late Professor Broca, I have condensed the following account from his classical work, "Sur le Siege de la Facultd du Langage Articule."

The anterior lobe of the brain comprises all that part of the hemisphere situated above the fissure of Sylvius (which separates it from the temporo-sphenoidal lobe), and in front of the furrow of Rolando, which divides it from the parietal lobe. The direction of the furrow of Rolando is nearly transverse ; starting from the interhemispheric median fissure, it descends almost in a direct course, but with some slight flexuosities, terminating below and outside of the fissure of Sylvius, which it meets almost at a right angle, behind the posterior border of the lobe of the insula ; in front this furrow is bounded by the transverse frontal convolution, and behind by the transverse parietal convolution.

The anterior lobe is composed of two stories or divisions, one inferior or orbital, formed by several convolutions called orbital, which lie on the roof of the orbit; the other superior, situated beneath the frontal bone, and under the most anterior part of the parietal. This superior division of the anterior lobe is composed of four fundamental convolutions, called ^t. frontal convolutions ; of these, one is posterior, the others are anterior. The posterior, slightly tortuous, forms the anterior boundary of the furrow of Rolando ; it is therefore almost transverse.

DESCRIPTION OF THE CEREBRAL CONVOLUTIONS, l^

and ascends from without inwards from the fissure qf Sylvius to the great median fissure which receives the falx cerebri ; it has been variously described as the posterior, transverse, or ascending convolution. The three other convolutions of the superior division are very tortuous and complicated ; they have all an antero-posterior direction, and running side by side, extend from before backwards over the whole length of the frontal lobe, terminating behind at the transverse frontal, into which convolution they all three enter; they are distinguished by the names of first, second, and third frontal convolutions. The first and second frontal convolutions call for no special remark, but the precise relations of the third are important. This convolution, by its superior border, is contiguous to the second frontal in its whole length ; in reference to its inferior border, the anterior half is in contact with the most external orbital convolution, whereas the posterior half is free, and forms the superior border of the fissure of Sylvius, which separates it from the temporo-sphenoidal lobe. In consequence of this latter relation, the third frontal is sometimes called the superior marginal convoliction, the name of inferior marginal being given to the superior convolution of the temporo-sphenoidal lobe, which forms the inferior border of the fissure of Sylvius.

In drawing asunder these two marginal convolutions which bound the fissure of Sylvius, the lobe of the insula is exposed, which covers the extra-ventricular nucleus of the corpus striatum. The result of these relations is that a lesion which is propagated from the frontal to the temporo-sphenoidal lobe, or vice versd, will pass almost necessarily by the lobe of the insula, and from thence, in all probability, it will extend to the extra-ventricular nucleus of the corpus striatum, seeing that the proper substance of the insula which separates the nucleus from the surface of the brain is composed of only a very thin layer.*

As this subject has more particularly engaged the attention of French pathologists during the last few years, it is most convenient to consider first their researches, as the early literature of the localisation of speech is especially associated with the names of Bouillaud, Dax, and Broca.