Volume 2

Aphasia and kindred disorders of speech / by Henry Head.

  • Head, Henry, 1861-1940.
Date:
1926
Catalogue details

Licence: In copyright

Credit: Aphasia and kindred disorders of speech / by Henry Head. Source: Wellcome Collection.

    15/476 (page 9)
    No. i (see p. i) was a case of extremely severe aphasia, due to an extensive gun-shot injury of the left half of the head. The missile entered in the fronto-temporal and made its exit in the temporo-parietal region; at this point there was a small hernia cerebri (Fig- V)- There was profound right hemiplegia, in which face and tongue participated; the upper extremity was flaccid, the lower hypertonic. At first he was completely speechless except for “yes” and “no” and he could not repeat even these monosyllables. He understood much of what was said to him, but was unable to execute simple oral commands with certainty. He could not read and failed to carry out orders given in print; yet he was able to point to the word on a list which expressed the object he desired. At first he wrote nothing but his surname and a scrawl, which somewhat resembled one of his Christian names. Copying from print was im¬ possible. He recovered power rapidly and it then became obvious that his defects of speech were mainly of the Verbal type. He talked slowly and with obvious difficulty. When repeating anything said to him, his articulation, though defective, was better than with spontaneous speech. He understood all that was said and executed even complex oral commands correctly. Although he succeeded in carrying out printed orders, he still failed to comprehend exactly what he read to himself owing to defects of internal verbalisation. He wrote badly, employing the left hand because the right was powerless; not only was the act of writing difficult, but the words were badly spelt. To dictation the faults were of the same character though less gross. He could, however, copy print perfectly in cursive script, evidence that the defect was intellectual rather than mechanical. He was unable to say the alphabet spontaneously and had great difficulty in writing the letters in due sequence. In spite of his University education, he was puzzled by simple arithmetical problems. Orientation was in no way affected and he drew from memory a perfect ground- plan of his ward at the hospital. He could play simple card games, but not bridge; puzzles he enjoyed and solved with ease. No. 20 (see p. 295) was a case of acute and severe aphasia in an elderly woman due to the removal of an extra-cerebral tumour, growing from the dura mater, which indented the brain around the meeting point of the inferior frontal and inferior precentral fissures. The operation was followed by flaccid right hemiplegia, loss of movement in the same half of the face and tongue, together with the usual changes in the reflexes on the paralysed side. At the expiration of sixteen days all abnormal signs had passed away and there was no difference between the two halves of the body. The loss of speech was at first profound and she could say “yes” and “no” only. The acts of speaking, reading and writing were all affected at first; even the power of under¬ standing what was said to her was somewhat disturbed. As she regained her capacity to use language, those aptitudes returned first which were least dependent on accurate word-formation. Clinically, within four months of the opera¬ tion, she had been transformed from a severe example of loss of speech into one of Verbal Aphasia, so slight that it might have been mistaken for an articulatory disturbance only.