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 vision, touch, etc., without leaning on the auditory region.
It is the minuter analysis of such individual differences as these which
constitutes Charcot's contribution towards clearing up the subject.
Every namable thing has numerous properties, qualities, or aspects. In
our minds the properties together with the 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
connection 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 whilst we think, the _ultimate_ process is utterance. If the
brain-part for _that_ be injured, speech is impossible or disorderly,
even though all the other brain-parts be intact: and this is just the
condition of things which, on p. 109, we found to be brought about by
lesion of the convolution of Broca. 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 is, as aforesaid, 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's mind the _look_ of an object or the _look_ of its name be
what habitually precedes articulation, then the loss of the _hearing_
centre will _pro tanto_ not affect that individual's speech or reading.
He will be mentally deaf, i.e. his _understanding_ of the human voice
will suffer, but he will not be aphasic. In this way it is possible to
explain the seven cases of word-deafness without motor aphasia 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 convolutions under
which those fibres pass which connect the visual centres with the rest
of the brain (see Fig. 47, p. 116). With this result Dr. Starr's
analysis of purely sensory cases agrees.
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