Académique Documents
Professionnel Documents
Culture Documents
N TT PT N TH P TH L F P H.
L.
DISTURBANCES OF SPEECH.
KUSSMAUL.
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770 KUSS~IAUL.-DlSTURBANCES OF SPEECH.
L.†D T RB N F P H.
ff t n nd d n b l t . Th t p r v l d n xt n v f f ft n
affection ended in imbecility. The autopsy revealed an ertensive focus of soften-
n n th l ft h ph r , n ll t n f f br h h, rd n t nd r,
H PT R XXV .
belong to those radiating from the corpus callosum.
rd D fn .†rd Bl ndn .†D r n nt f th pr v rP r pt v
p h tr n n r l.†l x nd ndr d D r n nt n th pr
h n n f th b l f xpr n.†pr x nd ph .
n d llt r t r f nd r rd d ph h h
h ld n t pr p rl b d n t d b th n , n th
p t nt r t ll bl t xpr th r th ht b p h nd
CHAPTER XXVII.
r t n . Th h dn tl t th p r th r f p n r f
rtn th r n l n r bl , h v r, lth h th h r
n p rf t, t nd r t nd th rd h h th h rd, r,
Word-Deafness.- Word-Blindness.-Derangements of the Impressive or Perceptive
lth h th ht p rf t, t r d th r tt n rd h h
Speech-track in GeneraL-Alexia and Kindred Derangements in the Compre-
th . Th rb d n b l t ll t l , n rd r t h v
nd rd bl ndn l t rd t v rb l .
Th d f t ld r l t d th r n r ll
In .medical literature we find cases recorded as aphasia which
f
bn d
rd f n
th th r d
n
ph
n t r , r
d r n
th
nt ,
r ph .
th
h v
n n l
h h r d. ,h v r, rr t ppr t n f th r
writing; they were no longer able, however, although the hear-
r bl ph n n n f th r t t p rt n f r th
ing was perfect, to understand the words which they heard, or,
pr h n n n t nl f ph rb d ff t n, b t l f
th h n f p h n n r l, t n r t t
although the sight was perfect, to re~d the written words which
th bj t f p l x n t n.
l , rd n th nn t nb t n th n pt n nd
th rd p d d n th d r t n fr th f r r t th l tt r,
p n , th xpr n ff r h n th nd, th nd r t nd
These defects seldom occur isolated ; they are generally
n .
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RD D FN ND RD BL NDN .
t th ntr f n pt n th pr v rp r pt v th
We call the entire tract which leads from the nerves of sense
th r, h h p th xpr n f th n pt n, th x
p n th xp v tr t. Th pr v tr t rv nl
other, which compasses the expression of the conceptiott, the ex-
f r th r pt n f rd p n r p t nt rtn b th r
th nt rt f th tr t. Fr th ln lf t th t ll
upon the expressive tract. The impressive tract serves only
pr ntl b nv t t d, th n l n v d nt th t, n th
t n f r th pr d t n f nd nd rd , n th pr
hence, the ability to learn to speak and to write depends upon
v tr t d ff r nt r n r r r d f r th r r pt n. F r
the integrity of this tract. From the clinical facts that will
th nd r t nd n f r nd nd th t f r p n rd , r th
nd r t nd n f r r tt n l tt r nd th t f r r tt n rd , r
presently be investigated, the conclusion is evident that, as in the
n t n p r bl b nd t th r, b t r d ff r nt th n . Th
t r r t n d. Th p r pt n f nd nd r r h h
r nd v d ll n n v l nd n n nt , nd th r
sive tract different organs are required for their reception. For
the understanding for sounds and that for spoken words, or the
rr n nt nt th t rd h hb th
b l f th r th t d , r d ff r nt f n t n , h h r
p rf r d n d ff r nt p rt f th ntr l t . Th ph
understanding for written letters and that for written words, are
not inseparably bound together, but are different things. The
f L rd t, f h h h v lr d r p t dl p n, n f
th t nt r tn x pl f nt r n blt t p d t
l f th r f r rd th pl t rd d fn nd
understanding for words can be lost, and that for sounds or let-
ters retained. Tl~e perception of sounds and murmurs which
rd bl ndn . ll l n r l ttl l n r v rh .
"J tr v pr v< d l v l rd t l t . l nr t t l
n , l d v n nt pr n tl ,p r j n v n pl d l
are indi1Jidually known as 1Jowels and consonants, and tltei'l'
n r d nt l f ll t l
nt, t tr ,l v t n
rd n r p
rt n
r l
h th r L rd t
xpr nt p n
nt r l d pr v d f th
." Th t t
p nh
n l
r, lth
rd, b t d t n tl
hh h rn
t t
pr
th t th
rv d nd h
rd f ll n pr h nd d
bl t r fl t
performed in different parts of tl~e central system. The aphasia
ph n nd ph l ph r p n h nd t n. n th B th tr r f
of Lordat, of which we have already repeatedly spoken, is one of
the most interesting examples of entire inability to speak d?.te to
rtn r l dt h th v n l .H ld tp , t  tr ,b t ld n t
r d. " n p rd nt l v nrd l nf t nd t nt nd ,j v p rd
l d l r n v bl .L nt x v td p r v l t , ^ lph b t
loss of the memory for words with complete word-deafness and
4
t d rr t tr t l j n t nd l ttr p rl f r t nd t ( t t n
t d 4f r .L r j v l j t r n pd l r l l vr j l ,
l
nd l d v t tt nt, j v d n l p b l t d n l r l t tr .
"Je me trouvai priv~ de la valeur de tousles mots. S'il m'en restait quelques-
pd
upon his ear, although his hearing was preserved and he was able to reflect as a
physician and philosopher upon his condition. In the same way the treasures of
writing were closed to him 1\S with seven seals. He could 1pell, it i8 true, but could not
read. "En perdant le souvenir de la signification des mots entendus, j'avais perdu
celui de leurs signet! visib1es. La syntaxe avait disparu avec les mots, l'alplwhet
http:
1eul m'etait ruti; mais la jonction des lettres pour la formation des mots ~tait une
T
«!tude ll faire. Lorsque je voulus jeter un coup d'oeil sur le livre que je lisais,
02 08 6:24
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f ll p l r l nt nt l pl p rt d t ." H d rb th d p
Il m'a fallu ~pelcr lentement la plupart des mots." He describes with deep emo·
t n th h pp nt h n, ft r v r l r t h d ,h ll dh z t
nd r v r h l br r , nd n xp t dl , fr t f rn r th rd "H p
tion the happy moment when, after several wretched weeks, he all~wed his gaze to
p r t p6r " fl h d p nh fr th b f f l .T r b r t fr h
wander over his library, and unexpectedly, from out of a corner the words "Hip·
. Th t nt r d th n nt f th pr v nt, h h f n ll
pocratis opera" flashed upon him from the back of a folio. Tears burst from his
eyes. That moment marked the commencement of the improvement, which finally
nd d n r v r .
n th r n t l p rt nt b rv t n r p rt d b Dr.
h dt, f n t r f ld, h th t rd d fn nd
ended in recovery.
rd bl ndn n p n n n d r n nt f p h
f n nt n r d , h h n th nf t d t lf b
r t . Th rd r nl p r v d nf d
Schmidt,' of Miinstermaifeld, shows that word-deafness and
r r, lth h th h rn v r d l t , nd lth h
l n ,b t l ld th tr bl b b n d nt rd .
of an intense grade, which in this case manifested itself by
n, t nt f v r f ,b dd nl n n ,d rn v r
n t p r l z d, b t ff r d fr ph nd p r ph . h f nd th rd
f th pr p r d, nd nj t d rr l r v rb r l rl . h th ht
t b d fb t f r t h d d n t nd r t nd n l rd. t nd
alone, but also could witlt some trouble be combined into words.
v r d, h v r, th t h h rd n n t th d r r th t n f t h
th t n , t . rd , n th th r h nd, h ft r rd t t d, r p r v d
nl nf d r r. h h rd p r t v l nd r p t d th .
st: aining at stool, ten days after confinement. After collsciousness returned sl1e was
h n rd f n ll bl p n n th rd n r , h d d n t nd r
not paralyzed, but suffered from aphasia and paraphasia. She found the words
t nd t, b t h n th d ff r nt l tt r r p r t d d t n tl fr h th r,
with difficulty or not at all, reversed or mutilated them, said "butter" instead of
th t th t d f rth n th pr n n t n, h bl t r p t th rd.
" th rd f r th n n ll bl t n r f r t t pr n n n l
"doctor," threw out letters and syllables, inserted others, used the infinitive instead
l bl d t n tl , th n n th r, th n th t t th r, r h ld n t nd r t nd of the proper mood, and conjugated irregular verbs regularly. She was thought
th rd. t th th n th r dn . h t d d th rd v r r
to be deaf because at first she did not understand a single word. It was soon dis-
covered, however, that she beard a knocking at the door or the ticking of a watch
f ll , nd tr d t pr n n th tfr t p r t l , nd th n t th r. R v
r t pl l l . h d d n t nd r t nd h rt nt n nt l ft r th l p
f h lf r, nd th n nl h n th r pr n n d l l nd d t n tl .
as clearly as a well person, that she could distinguish between two house-clocks by
v n t th l t th r r n d l ttl d ff lt n p n .
the tone, etc. Words, on the other hand, as she afterwards stnted, were perceived
4
P t nt h ff r fr rd d fn nd p t th
only as a confused murmur. She heard separate vowels and repented them.
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t th blt t xpr th lv n rd , b t
When a ·word of one syllable was spoken in the ordinary way, she diu not under-
l
stand it, but when the different letters were separated distinctly from each other,
pd
so that they stood forth in the pronunciation, she was able to repeat the word.
With words of more than one syllable it was neces!.'ary first to pronounce one syl-
lable distinctly, then another, then the two together, or she would not understand
the word. It was the same thing with reading. She studied the words very care·
fully, and tried to pronounce them at first separately, and then together. Recov-
.h th tr t. r
ery took place slowly. She did not understand short sentences until after the lapse
of half a year, and then only when they were pronounced slowly and distinctly.
Even at the last there remained some little difficulty in speaking.
1
Allg. Zeitschr. f. Psychiatric. 1871. Bd. XXVII. S. 304.
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RD D FN ND RD BL NDN .
n th nd f b rv r th pr n th t th r r z d.
many words in the wrong places, and often distort them, leave
Th b rv r tb nh rd t v d f ll n nt th rr r,
r rd n th p t nt t n d f nd d nt d. Th
The observer must be on his guard to avoid falling into this error,
p t nt h v p rf tl rr t d , b t th rr t xpr
or into the still greater error, which has also been committed, of
regarding the patients as at once d~af and demented. The
n f r th nt n th rd , nd n t th th ht , r
nf d. Th ld v n nd r t nd th d f th r f
th ld nl nd r t nd th rd . Th r n th p t n
patients may have perfectly correct ideas, but the correct expres-
fp r n dd nl td n n th d t f p p l t n h h
th nd , b t d ff r nt rd , th tr n p n
sion for them is wanting ; the words, and not the thoughts, are
th r r n n nt ll bl l tt r. Th tt pt th lv
d rn h ldh d, b t h d l t nt r l f r tt n l n b f r .
Th n l n r, h v r, f nd th r ht rd , nd th h h
B ll r r d n tr t d n th t p r n h h db n
r rd d b th d f nd d nt d, r ll n th r n n r
h h th n, h ddn t v n n h r nn n
r , p n dh rd nn t dd r , th t p rf tl
during childhood, but had almost entirely forgotten long before.
They no longer, however, find the right words, and those which
d tn t d x t d b h nd th pp r nt nf n. nl
n n n p r n, b lr d n l d f Jt r n nd t n,
nd n v r d d n th n ll .
they find are uttered in distorted and incomprehensible shapes.
Baillarger 1 demonstrated once that a person who had been
rn d rb dt v r n tr tv f th nd.
n f th n h h tr t d f r th d n
d r d b th tt nd nt t b d f.
r egarded as both deaf and demented, was really neither one nor
the other. He concluded, from the expressive gestures with
B th n r dv n d n r . n p rf l x n t n, n f
th d th pr n th t h n n , p rtl b h r n r ddn t
rr p nd t th n f th t n , p rtl b h d nv rt d nd d
which the woman, who did not even know her own name any
t rt d
f
rd . Th
nd t b r t n l
nn fh r
r
nt n
v r, h r nt r b h v r
,h v r, ld b
l
nr v l d nd
n bl . h n
more, accompanied h er disconnected discourse, that perfectly
x t d h ft n p t rr tl . h n h tr d t rt h nl d
distinct ideas existed behiud the apparent confusion. Unlike
l
p nd d
t th
n tr
blt t r
, nd
d.
n l n r bl t pr d l tt r h h d l
D r ph t h pt n pl x. Br l . 8 4. F ll . 2.
l
One of the women whom he treated for this disease was con-
sidered by the attendant to be deaf.
pd
was found to be rational ; moreover, her entire behavior was always sensible. When
excited she often spoke quite correctly. When she tried to write she only made
up and down strokes, and was no longer able to produce letters; she had also
lost the ability to read.
Gradually she learned to speak almost correctly again and to read aloud with-
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774 KUSSMAUL.-DTSTUHB.ANCES 0~' SPEECH.
L.†D T RB N F P H.
th t t n. h l r n dt xt nt th p r fâ rtn h ld
out hesitation. She also regained to some extent tho power of writing; she could
p fr r tt n n r pt, b t ld pr d n rtn nl f lf h n
rd t t d rd .
copy from written manuscript, but could produce in writing only a few self-chosen
Th th r p r n, h l ff r d fr p r ph , tfr t pp dt b
or dictated words.
d f nd r z . t th t p th r f nd, t th r th tr ph f ll th
The other person, who also suffered from paraphasia, was at first supposed to be
deaf and crazy. At the autopsy there was found, together with atrophy of all the
nv l t n , p lp , thr b t ft n n f th f r t, nd f r t p rt f th
nd l ft t p r l nv l t n.
Tl rd d fn n nl b nf nd d th n n
couvolutions, a pulpy, thrombotic softening of the first, and of a great part of the
d fn h n th b rv r nt nt h lf th p rf l
second left tempoml convolutiou.
x n t n, n t t v r f th f t th t th p t nt
p r v nd p tt nt n t ll , n , nd r r .B
r r n n t n f t ll b f nd n f p pl x r
deafness when the observer contents himself with a superficial
p rt d b B n . Th f t tr n , h n b r n nd
h n th rh p .
perceive and pay attention to calls, noises, and murmurs. Be-
p h bl ndn r r fr ntl th n p hd f
f n n h p , h h ll p th r ht h lv
rare; an instance of it will be found in a case of apoplexy re-
f b th r t n f r n n blt t nd t pr h nd l tt r
rd n th l tt r r rd d r d n t f ll p n th
the frequent simultaneous appearance of aphasia and anosmia, 2
r n n p rt n f th f ld f v n, th h p p t nt n
hemiancesthesia, s or hem-iopia.•
t n t nd r d, t n th r n t. h n th p r fr
nzn rd nd l tt r t ll p rf t, t t d t t th
Spf.eclt-blindness occurs more frequently than speech-deaf-
h p , b t th r t d ff lt. t th n fr ntl b
b r b d t th h p , nd h h t th r rl
of a genu-ine hemiopia, which usually occupies the right halves
pl t l f th blt t ppr h nd l tt r nd rd .
pr n. Th p t nt n p rh p t ll r d rd r
and words.
D bl n rt. R v. F br., 86 .
h r. Tr n t. L . p. 26 . p r l th d rb d n h p. XX X., p. 8 ,
remaining portion of the field of vision, the hemiopic patient can
n h h th tbr f ph p n d b h ll n t n f ll.
at one time see and read, at another not. When the power of rec-
ognizing words and letters is still perfect, it is easy to detect the
h v d t l d v r l b rv t n f th rt, r p rt d b rn , P rr d,
4
nd th r .
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and others.
T
• Bander, loo. cit. Fall 9. Bernhardt, Berlin. klin. Woohensohr. 1872. No. 32.
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P bl D
RD D FN ND RD BL NDN .
, pr d
nn l n
th r ll bl
r pr n
nd
n
rd . Th r
t, r, h n h tr
l t t f th
t d
rn
t n h n ph n
. Th p t nt , . ., r
n , tn
d ff,
th b
hl p
rv t n r p rt d
n , th
case can then scarcely be unravelled and we stumble across the
n p n th t v rn n n th tr t, b t r n v rth l
most astonishing phenomena, as witness the observations reported
n
Th
p bl
r
fr
n z th
d n l tt r
nd v d
nd
l l tt r , b t r
rd th t
n bl t
d z .
th
nn t r
rd th
d th
n th t tl
nd v d l l tt r .
f .b
p t nt r
, b t n t th rd
incapable of reading letters and words with a steady gaze.
h ll r n th t f n hb r n n .L n rd r p rh p They recognize the individual letters, but are unable to
l bl
ft n r d r n l
n t ll b pr p rl
nl f r th r
n, th r
n th t,
t
h l th f r t
nn t, nd th rd
l
put them together to form words, or, vice versa, they read the
th n t ll d t rb tr r l n rd n th th d ll d words but cannot read the individual letters. A patient recog-
p b th f r t
rn d
ll bl (B rnh rdt .
v r r r nr rd t th
nizes the word Goethe on the title of a. book, but not the word
blt t pr h nd r tt n r pr nt d h r t r .H ll d Schiller on that of a neighboring one. Long words are perhaps
tt nt n t th f
f nt ll t l
t th t th
lt v t n. Th n d
l d p nd nt p n th d
t d n, h b t
r
often read wrongly only for the reason that, while the first syl-
l ttl pr t d nr dn , n nl nd r t nd th rd r tt n lable can still be properly seen, the rest cannot, and the word
l
th th
dt h
d f th r p
lf, b
n
, f r th
h l
nd r t nd n
t r d th
f th
rtn
ht
is then filled out arbi~rarily in accordance with the idea called
,h r r th d f th nd . Th h l r up by the first syllable (Bernhardt').
l n
tr n l t n th
v r p
r tt n
, nd nd r t nd
rd nt p
t
n
nn
rd . Th f r t
th tfr t
ll
Wernicke made a very sagacious remark in regard to the
pr nt th pt f l x n dd t n t th ph th
ability to comprehend written or printed characters. He called
pr
th r
nt th
n nd r t nd
t tr n
r tt n l n
ntr tt h
, nd h
n blt t
blt t d
nd r t nd
attention to the fact that this is also dependent upon the degree
p nl n . n th th r h nd, h nh tt pt t r d qf intellectual cultivation. The uneducated man, who is but
l d, h b ph n p nt n p n .
t d bt th t pl t t xt bl ndn x t, lth h th
p r f ht, th nt ll t, nd th p r f p h r nt t.
r n d ft r r v r fr ph , , . ., n th rd "z r h tt rt" nl
images, he requires the aid of the sound-images. The scholar
4
th f r t ll bl , "z r," d t n tl .
B ll, d l d. d r & . b .N . 6 nd .
translating the written words into spoken words. The first will
l
remained after recovery from aphaaia, saw, tJ. g., in the word "zerachmettert" only
T
1
Bull. de l'aca.d. de mCd. beige. Nos. 6 and 7.
n r t d n 20
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n, f rt f v r f , tr th p pl x hl n th nj
A woman, forty·five years of age, was struck with apoplexy while in the enjoy-
nt f th t bl n h lth. ft r h r n n r t rn d, b t
h p r l z d p n th r ht d , nd h d p n v r th l ft h r nt ll
ment of the most blooming •health. After some hours consciousness returned, but
n h t d ll, th r , th p h fr . x l t r, th ~;he was paralyzed upon tho right side, and had pain over the lP.ft eye; her intelli-
p r l nd th n f r nd nt ll n h d l td pp r d.
gence was somewhat dull, tho memory weak, the speech free. Six weeks later, the
paralysis and the weakness of memory and intelligence had almost disappeared.
T nth ft r th tt h d v r d th t h ld n l n rr d pr nt n
nd rtn . h th t xt, d t n h d th f r f th l tt r , nd ld
v n p th t xt, b t n p bl f tr n l t n th rd nt p n rd
Two months arter the attack she discovered that she could no longer read printing
nd th ht . h ld pr h nd p t r , nd d ph r r b h nd r
and writing. Sh~ saw the text, distinguished the forms of the letters, nud could
t d n ntl d r ph r pr nt t n , b t n t rtn ." h nv nd n
even copy the text, but was incapable of translating the words into spoken words
b l p bl h d th b rv t n, th p t nt h d lr d r n d th p rt
r d rd f n nd t ll bl .
and thoughts. She could comprehend pictures, and decipher a rebus; she under-
Br db nt n t n l r r bl b rv t n. stood consequently ideographic representations, but not writing. When van den
v r nt ll nt nd n r t n, ft r ff r n fr r br l pt
Abeele published this observation, the patient had already regained the power to
(h d h ,v tn ,d lr ,l t nt r l th p rt r d pr nt n nd rt
nd rr
th t xt, b t d d n t nd r t nd t, lth
tl b th fr d t t n nd p nt n l .H
hh
nv r
ld t ll
t n
rt
d
l
•
nd h v b l r v r l r ,b t n ll th n f tr t ,p r n , nd
Broadbent 1 communicates a no less remarkable observation.
th n f l dh h n t bl t n nd nd th pl t nd t
f l r bj t h h r h ld p b f r h . H d d fr n xt n v h A very intelligent and energetic man, after suffering from cerebral symptoms
rrh nt th l ft t p r ll b , th r pt r nt th v ntr l . T ld
(headache, vomiting, delirium), lost entirely the power to read printing and writ-
ing. He saw the text, but did not understand it, although he could still write easily
h rrh r f nd, n n th l r b rd r nv l t n f th l b th
th r nd l r r n , h h h d pr d d ft n n f th n hb r n r
br l b t n , l t d n th r nb t n th l r nd f th f r f
and correctly both from dictation and spontaneously. His conversation was good
lv nd th v ntr l t th p nt h r th d nd n h rn v n ff.
and his vocabulary very large, but occasionally the names of streets, persons, and
n th , th r f r , th nd t n f th rd
things failed him ; he was not able to name on demnnd the simplest and most
t th t r ntr f rd n t n f r rtn t ll p r
f t, h l th t xt ld n l n rb pr h nd d.
familiar objects which were held up before him. He died from an extensive hem-
n n l n, t r h r f r v r tr n b orrhage into the left temporal lobe, with rupture into the ventricle. Two old
rv t n r rd d b tph l.2
hemorrhages were found, one in the lower border-convolution of this lobe; the
H xh b t d t th tn f th t f r nthr p l , r tr d t r,
h ,b d h pl , pr nt d th ph n n f n n pl t ph .H
other and larger one, which had produced a sortening of the neighboring cere-
nt ll nt, b t h r f rp l rn d b h rt p r d. H p
bral substance, was located in the region between the lower end of the fissure of
fl ntl , b t h ld n t f nd nd d d n t nd r t nd f rd . H ld rt
Sylviusand the ventricle at the point where the descending hom was given off.
v r ll fr d t t n, b t h rtl ft r n bl t r d th rd h h d
,h v r, h h lf v r l rl xpl n d, h d d nr d n th
rd h h d r tt n fr d t t n p n th t bl t H p dh fn r v r
l
*Z t
L . t.
hr. f. thn l
8.
.
fect, while the text-images could no longer be comprehended.
In conclusion, we must make room here for a very ~trange ob-
pd
was intelligent, but his memory for pieces learned by heart was impaired. He spoke
fluently, but be could not find and did not understand a few words. He could write
very well from dictation, but shortly after was unable to read the words he bad
written, and he suffered in general from complete alexia. By means of a strata-
gem, however, as he himself very clearly explained, be succeeded in rending the
word he b~ written from dictation upon the tablet. He passed his finger over
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RD D FN ND RD BL NDN .
d n . H th n d rt f l l t n, nd nt d ff th f th p r t
each letter of the written word 1\.8 if be were writing it again and read it while so
l tt r .
doing. He then made a sort of calculation, and counted off the sum of the separate
xpl n th ph n n n b th th r th t th n
letters.
t ll nt n n h t tr n p th v nt f
b n th nt t rd . Th t pr v ,
p r l , th t th r n t nl p th l dn
telligent man knew lww to t1·anspose tlte movement-images of
tlte written letters into acoustic sound-images, and how to com-
fr th t ntr f rd t th t r ntr f r
r tt n rd , b t l n fr th l tt r t th f r r. t
th t th tr n th n th th r f th x t n
bine these into acoustic word-images. rrhe case seems to prove,
as Spamer also assumes, that there is not only a path leading
f v nt , h h p n th pr d t n f rd
b th t n f th l r pp r t .
r n r ll d tt nt n t th f t th t n ph ,
from the acoustic centre of word-images to the motor centre for
h nr t dt t
th r p rt, . ., th n
h p rt n f th b d , t
n t d f th r, th
h n t
tb n
d
written words, but also one from the latter to the former. At
r f th t .H rb d tt nf nd n f th
the same time the case strengthens the theory of the existence
f th
v nt , b t t
rd h rd,
r
v.
rr
dd n th
tt rb
ht. Th r
tt nf
t n
nd n
J t th nd r t nd n f r r tt n rd nb l t,
f rf r ,b th ddn t n h t th f r nt b f r
th t 6 (Tr . n th r ph , n th th r h nd, l
some other part, e. g., the nose instead of the ear, without being
th hh ld n l n r nt n rd , ld dd nd b
tr t n p p r, nd v n lt pl nd d v d pr tt ll
aware of the mistake. He ascribed it to a confounding of the
(Pr t.N
t nd n f r ln t , lth hh t ll bl t pl
of the words heard, as v. Gudden' thought. There is question
ll b r (F n lnb r . nv r l ,L n
nn t n l d h hh h rd. n th r p t nt f Pr t
pressive tract. ·
rr p nd nzbl tt f lr h z. rzt . Bd. ., b d rD n b rd nV r
tr B r r .
· Just as the understanding for written words can be lost, so
n Pr t, l . t, p. 0.
can that for figures. An accountant read ·off the sum 766 figure
4
for figure, but he did not know what the figure 7 meant before
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l
1
Correspondenzbla.tt fiir Schweiz. Aerzte. Bd. L, bei der Discussion fiber den Vor·
T
trag Biermer's.
l d tz d
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8
L.†D T RB N P H.
778 KUSSMAUL.-DISTURBANCES 01<' SPEECH.
bl t rt nn t , nd v n t p , nd
nd r t d l n l d h hh h rd, b t n bl t was able to write music in notes, and even to compose, and
pl fr
t
n t .
p t nt p dr n , lth h th
understood also any melody which he heard, but was unable to
nn t pr d th p nt n l . h th r r n t th r play from notes.
v r
n ph
r r
r n l n
n bl t
r bl t d t n
.
h rt nt
Sometimes we see patients copy drawings, although they
p f n th f r t th nv nt n l lf r , nd cannot produce them spontaneously. Whether or not the re-
th r l
nd f r , nd tr t
t
t
nd
p
n th
th th l tt r. n th l
v n nf nd th
t
p n
h h th th n
l t
r
ll
xpr
th nd r t nd n f r th
d. Th f r r nd t n
n
t
pieces .o f money; they forget the conventional social forms, and
n tb nf nd d th ph , h hh t d l nl th
the religious customs and signs ; they even confound the spoon
th
b n
n b h h th
tt d h v r.
d r
h v
xpr d. Th
n th t th nt ll
t h
t
and fork, and try to eat soup with the latter. In the last case
b p rf tl pr rv d n f ph , b t th n v r th
the aphasia is combined with apraxia-tiLe memory for the
n pr x .
H PT R XXV .
uses of th-i ngs is lost as ·w ell as the 'U nderstanding for the s-igns
h t D r f th ntr nd Tr f p h.
by wk'ich tlw things are expressed. The former condition must
N th t h v rr v d t th p nt, h hp r t t
ln lf t , h h r f r v l nt t n xp r
the signs by which the ideas are expressed. This mistake has
nt l r lt , th n th t h t ll tr t b
f r d nr rd t th r nn t n .
be perfectly preserved in cases of aphasia, but this is never the
B n , rn (l . t. , nd p r (l . t. h v
case in apraxia.
pr d d n th tt pt t f r h h t dr n .
Th d r fB n n rr tf rt r n : t
nn rl t bl h p l ntr f r th r , nd
ntr f rd n t n, h h b l v t b n rr t.
&hematic Diagram of the Centres and Tracks of Speech.
rn d th t fl t n th ntr np r
B rl n r l n. h n hr. 8 .N . 6 nd .
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