An Address on Aphasia: Read before the Birmingham Branch of the British Medical Association on November 15th, 1910
Authors: R. Saundby
Journal: BMJ (1911)

I HAVE had recently under my care two cases of aphasia which terminated after a few weeks' illness, and we were able to complete our notes by careful post mortem exami- nations.They illustrate the two principal clinical types of aphasia and the lesions associated with them, and may serve to introduce a discussion of the recent criticisms which have been directed against the doctrine of Broca.These types are:(1) Motor or Ataxic Aphasia, in which inability to speak is associated with paralysis of the right side of the body.This is generally held to be dependent upon a lesion of the third left frontal convolution or the fibres coming from it.(2) Sensory or Amnesic Aphasia, in which the patient can speak although his vocabulary is limited, and he uses wrong words, but he can neither read nor write, although his eyesight is good and the movements of his hands are notaffected.In this the lesion is localized in the neighbourhood of the first temporal sphenoidal convolution, the angular gyrus and the supramarginal convolution.The first case illustrates the former type.CASEI.-Mlotor Aphasia.J. M., coachman, aged 64, was admitted to the General Hospital on February 17th, 1910, with a history that three days before he had suddenly lost his speech; he was at dinner, and when his wife spoke tohim he could not answer her; he wanted to re.turn to work, and was annoyed when she stopped him.Theie was no convulsion, orany sign of paralysis or loss of con- sciousness.When admitted he was quite unable to speak, and could make only inarticulate noises when pressed, but he seemed to understand all that was said to him, and was able to read and write.He could do a simple addition sum, but when set an equally simple sum in division he failed.There was slight flattening of the lower part of the right side of the face, and the tongue deviated towards the right side, but there was no weakness of the right arm or leg; the knee-jerks were normal on both sides, and the plantar reflexes were flexor.His pulse was 56, blood pressure 120; the artery felt thickened; the heart was not enlarged, its sounds were normal; the urine was free from albumen.On February 23rd some weakness of the right hand was noticed, and later on he lost the power of writing, became dazed and stupid, and by midday hecould not be roused to take his food.The right side of the face was paralysed,and tberight arm and leg were motionless and slightly stiff.The right plantar reflex had become extensor, and the leg was not drawn up, while on the left side it was flexor, and the leg was drawn up briskly.He lay in this condition for three or four days, but on the 27th he improved, and showed response when spoken to, but could not speak, and the right arm and leg were completely paralysed.On February 28th he was found to have lost the power of reading, and the attempt to write his name with his left hand was a miserable failure.He went on for some time without any change, but on March 17th there was a sudden rise of temperature, reaching on the following day to 102.80, and after that his temperature remained irregular until he died on March 31st.Necropsy.