Volume 1

Aphasia and kindred disorders of speech / by Henry Head.

  • Head, Henry, 1861-1940.
Date:
1926
    LIST OF ILLUSTRATIONS VOLUME I Fig. i. Diagram illustrating the relations of the different word centres and the mode in which they are connected by commissures . . . page 56 2. Diagram showing the approximate sites of the four word centres and their commissures .......... 60 3. To show the “quadrilateral” of Pierre Marie in horizontal section . 70 4. Illustrating the man, cat and dog tests . . . . . . 154 5. Illustrating the hand, eye and ear tests . . . . . . 159 6. Illustrating the hand, eye and ear tests ...... 161 7. To show the site of injury to the brain in Nos. 6 and 17, cases of Verbal Aphasia ............ 445 8. To show the site of the injury to the brain in Nos. 13, 14, and 15, cases of Syntactical Aphasia ......... 449 9. To show the course of the bullet through the left temporal lobe in No. 15, a case of Syntactical Aphasia . . . . . . . 451 10. To show the site of the injury to the brain in Nos. 2 and 7, cases of Nominal Aphasia .......... 456 11. To show the site of the injury to the brain, seen from behind, in Nos. 2 and 7, cases of Nominal Aphasia ....... 457 12. To show the site of the injury to the brain in Nos. 8, 10, and 18, cases of Semantic Aphasia .......... 460 13. To show the site of the injury to the brain, seen from behind, in Nos. 8, 10 and 18 to the left and No. 5 to the right of the middle line . . 461 14. To show the site of the injury to the brain in No. 5, a case of Semantic Aphasia ............ 463 VOLUME II 15. To show the wounds of entry and of exit in No. 1 . . . . 3 16. To show the limitation of the fields of vision in No. 2 . . . 16 17. Spontaneous drawing of a camel by No. 2 ..... 22 18. Attempt by No. 2 to draw an elephant to command .... 23 19. Elephant drawn to command by No. 2 after he had recovered his powers of speech to a considerable degree (March 1921) . . . 48 20. To show the injury to the skull in No. 9, a case of Verbal Aphasia . 125 21. Attempt by No. 9 to draw an elephant to command .... 131 22. To show the limitation of the fields of vision in No. 9 . . . 137 23. The alphabet, written spontaneously by No. 10 .... 155 24. To show the situation of the bullet wound in No. 11 . . . . 183 25. To show the limitation of the fields of vision in No. 11 (June 1915) . 184 26. To show the limitation of the fields of vision in No. 11 (March 1924) . 190 27. Attempt by No. 15 to draw an elephant to command .... 232 28. Attempt by No. 21 to draw an elephant to command . . . . 324 29. To show the limitation of the fields of vision in No. 22 . . . 331 30. Successful attempt by No. 25 to draw the head of an elephant . . 385
    APHASIA AND KINDRED DISORDERS OF SPEECH PART I CHAPTER I FROM THE SCHOOLMEN TO GALL The evolution of our knowledge of cerebral localisation is one of the most astonishing stories in the history of medicine. Through¬ out the middle ages the brain was supposed to contain three ventricles, each of which was the dwelling-place of one or more aspects of the soul. The anterior chamber received the nerves of taste, smell, sight and hearing, and was the situation of the “ Sensus Com¬ munis”; in the middle ventricle dwelt the faculty of cogitation and reasoning, whilst the posterior one was the seat of memory1. This doctrine appears to have started from Herophilus and, although Galen placed the site of the activities of the mind in the substance of the brain, it persisted until it was rendered untenable by the dissections of Vesalius, in the early part of the sixteenth century. But theories continue to exert a subtle influence on medicine long after they have ceased to be reasonable; in 1798, Soemmering thought the seat of the soul was in the fluid which filled the ventricles, and even as late as 1844, the author of the article on psychology in Wagner’s Handworterbuch der Physiologie states that there are facts “which make it very probable that the cerebral ven¬ tricles are the organ which stands in the closest relation to conscious¬ ness2.” With the revival of learning the discussion of the relations between mind and body underwent a fundamental change. A return to the teaching of Aristotle that human reason depends on the senses and imagery made the existence of the mind dependent on bodily activities. This led to the conception that the soul in all its aspects, both higher and lower, was inseparable from the body and incapable of surviving its dissolution. Accurate anatomical knowledge acquired by dissection destroyed the fantastic dogmas of the Schoolmen about the ventricles, and attempts were made to bring the vital activities of the brain into harmony with the 1 [124], pp. 179-180, 204. 2 [128], p. 705.
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    more openly and clearly to be endowed with the faculties of the chief soul. Indeed the more I examine the nature of the heart, the liver, the testes, and the organs secondary to these, the functions performed by which are, there can be no doubt, the same in us as in other animals, and the more I persuade myself that we ought not to draw conclusions concerning the operations of the chief soul, other than those taught by our most holy and true religion, the more I wonder at what I read in the scholastic theologians and the lay philosophers concerning the three ven¬ tricles with which they say the brain is supplied. The revolution in anatomical knowledge produced by the work of Vesalius did not preserve him from enunciating such purely metaphysical doctrines with regard to the functions of the body. These would have been of little historical importance had they not influenced all the theories put forward up to the end of the eighteenth century to account for the relation between the structure and functions of the nervous system. The brain was supposed to secrete thought as the liver forms the bile. Harvey’s discovery that the circulation of the blood obeyed mechanical laws applicable outside the body helped to destroy the idea of a vege¬ tative soul and belief in the existence of vital spirits. Descartes cited it to support his view that all the activities of the body are the mechanical consequence of their structure. Animal life is inanimate and automatic; man alone is endowed with the power of thought and possesses an im¬ material soul. The seat of this action of soul upon body is the brain, which from the time of Descartes onwards was universally recognised as the sole organ of mind. For him even the animal spirits which flow along the motor nerves are the result of filtration from the blood; the soul no longer animates the whole body in different forms, but exerts its influence through the pineal gland, chosen for this purpose because of its proximity to the ventricles of the brain1. Throughout the eighteenth century the doctrine of the relation be¬ tween mind and matter became increasingly metaphysical; soul and body were thought to be coexistent but independent factors in the life of man. Knowledge of the structure of the nervous system grew steadily, but up to the end of the eighteenth century the brain was looked upon as a single organ from which flowed vital energy under the influence of the will into all parts of the body. The nerves formed the channels for this distribution, and all of them consequently took their origin in the brain. Gall was the first to suggest that the apparently uniform mass was made up of organs which subserved the vital, intellectual and moral 1 Even in 1851, Lotze postulated a central seat of the soul in the brain.
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