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.

    32/476 (page 26)
    A fortnight after he was wounded, there was a little weakness of the lower portion of the right half of the face and the tongue deviated slightly to the right. There was no loss of motion or sensation. The right plantar reflex gave an upward response and that from the right half of the abdomen was diminished. All these abnormal signs passed away entirely within five months from the date of the wound, leaving only the upper quadrantic hemianopsia, as far as such a condition could be observed in the one remaining eye. Ultimately he developed epileptiform attacks, preceded by an aura of smell and taste characteristic of a lesion within the temporal lobe. His speech was jargon and the defects in the use of language assumed the form of Syntactical Aphasia. No. 13 (see p. 198) would have been equally valuable from the point of view of localisa¬ tion, had it not been for the uncertainty introduced by the operation carried out at the Front. He was struck by a shell fragment in the left temporal region and, when he came under my care some three weeks later, there was a linear surgical scar extending from the fronto¬ temporal to the parietal aspect of the scalp. On this healed incision was a pouting sinus, which lay 8 to 9 cm. from the middle of the scalp and was level with a point 16 cm. along the nasion-inion line. Here bone had been removed over an irregular area; when plotted on the surface of the brain it was found to lie just behind the central fissure. But exactly below this area, 11 cm. to the left of the middle line, lay another fungating sinus penetrating the bone. This orifice in the skull was at a distance from the surgical incision and had not been subjected to operative treatment of any kind. It undoubtedly represented one of the original wounds and, when plotted on the surface of the brain, lay over the upper portion of the first temporal gyrus and the Sylvian fissure, on a level vertically with the foot of the postcentral fissure (Fig. 8, Vol. 1, p. 449). I should like to suggest that this was the lesion responsible for the specific form of the loss of speech. The patient on receipt of the wound was obviously aphasic and the missile had probably injured the skull in the neighbourhood of the Rolandic region. The surgeon therefore trephined over the central fissure, but paid no attention to the small wound at a lower level over the temporal lobe, which had also perforated the skull. He had no fits and showed very few abnormal physical signs of injury to the brain. At first the movements of the right angle of the mouth were slightly less than those of the other side and the tongue was protruded a little to the right; but this passed away quickly. The right hand “felt different”; the grasp was comparatively feeble, the fingers were somewhat hypotonic, but individual movements were possible. There was distinct ataxy of the fingers with the eyes closed, and the power of recognising passive movement and posture was defective in the right hand. All other forms of sensibility were perfect. The lower extremity was unaffected. All the reflexes were normal, including plantars and abdominals. These abnormalities of the right hand during the earlier stages are accounted for by the wound over the postcentral convolution. On the contrary, the typical Syntactical defects of speech were probably due to the coincident injury of the first temporal convolution. No. 14 (see p. 215) suffered from a much more severe injury, lying, however, exactly in the same situation as that of the effective wound in No. 13. He was hit by a fragment of shell casing or by shrapnel just above the insertion of the left ear. When I saw him six weeks later, the wound was represented by a