CHAPTER XV. * ON APHASIA AND ITS LEGAL RELATIONS. APHASIA is the name given to the disease which is manifested by a loss of the faculty of speech. This is a loss of speech which occurs while the organs of phonation are to all appearance perfect, and while the intellect is unimpaired. This deprivation is sometimes general and sometimes partial. Thus, in a case mentioned by M. Broca, the individual answered every question by means of the single monosyllable "Tan," and Sir Thomas Watson† speaks of a gentleman who misappropriated words; thus, when he wished to say "camphor," he made use of the word "pamphlet ;" and Dr. Bergmann has described a case in which the memory was, owing to an injury done to the head by means of a fall, affected in a peculiar way. The man forgot proper names and nouns, and at the same time he had a perfect memory of things and places, and he could pronounce correctly any verb. Many other cases might be quoted to show in what way the morbid conditions of the brain manifest themselves. However, it is not our duty in this place to do more than indicate the existence of such a morbid mental condition, and to point out in what way it may be recognised, and how its existence, when proved, must modify the legal relations of the individual in whom it occurs. This is not a place for the consideration of the interesting questions with regard to cerebral pathology which have arisen in connection with this subject, or to trace the curious confirmation which has been given by the modern physiologists, some of the ablest of whom have * Sur le Siége de la Faculté du Langage Articule. + Practice of Physic,' vol. ii, p. 511. 6 ‡ Einige Bemerkungen über Störungen des Gedächtriess und der Allgemeine Zeitschrift für Psychiatrie,' 1849, s. 657. ascribed aphasia to a lesion in the posterior part of the third frontal convolution of the left hemisphere, to the theories of phrenologists. A comparison of Dr. Bateman's papers* upon Aphasia with some of those contained in the Phrenological Journal'+ will prove this interesting fact. There can, however, be no doubt of the existence of this very curious phenomenon, and it is manifested in various ways. Dr. Falret has made the following classification of some sixty-two cases which he has collected from various authors.‡ 1. All those cases in which the patients, whilst retaining intelligence and integrity of the organs of phonation, can only remember or articulate certain words or classes of words, or even certain syllables or letters, but who can repeat and write any word that may be suggested to them by others. 2. Those who are only able to pronounce spontaneously certain words, syllables, or phrases always the same, not being able to repeat other words dictated to them, and who yet retain the power of writing or even of reading. 3. Those more rare cases in which the patients can only pronounce certain words always the same, which, aided by gesture, enable them to express their thoughts, the power of reading, writing, and repeating words being abolished. M. Broca mentions a very interesting case falling under the last of these three class descriptions. The individual who in this case suffered from aphasia used four words, and attached a definite meaning to each of these four. The words saved out of the wreck of a vocabulary were "oui, non, tois (for trois), and toujours." When he wished to affirm he used the first, when he wished to negate he used the second. By the third he expressed all ideas of number, but he was conscious that it did not convey all his meaning, for when he wished to show that the number meant was more than three he held up his fingers. This gesture was an accurate indication of the state of the case. Whenever none of the three first words would do he used the fourth, toujours, which, as may be understood, had no very definite connotation.§ Now, these cases and many more of equal interest, which will be found quoted and narrated in the works already referred to, indicate the necessity of the recognition of this * See Journal of Ment. Sci.,' vol. xiii, p. 521, vol. xiv, pp. 50, 345, 489. See also Trousseau's Clinique Medicale,' tom. ii. + See vol. iii, pp. 26, 616, &c. Des Troubles du Langage,' p. 5. § See another case, 'Phrenological Journal,' vol. xii, p. 155. disease by those persons who devote themselves to medical jurisprudence. If a man loses the faculty of speech, if he substitutes one word for another, if he says "No" when he wishes and means to say "Yes," if he has a vocabulary limited to four words, and at the same time is in possession of all his intellectual faculties, it is surely evident that he cannot occupy the same relation to his fellowmen that those persons do who are possessed of a sufficient vocabulary to carry them through life with its ordinary business transactions; and it is surely clear that, just as there are peculiar provisions for those who cannot write, so ought there to be some provisions for those who cannot speak. The four or five words of the man mentioned by Broca are very much in the same relation to his intelligence that an illiterate person's mark is to his. Most of the people who are dumb are dumb only because they are deaf, and the law, upon account of the impossibility of their acquiring any adequate knowledge, has looked upon them as idiots, but it is a very different matter where speech has been lost owing to some bodily disease or local injury. In these cases education has raised the individual to the ordinary level, and the mere obliteration of a piece of local memory, of a portion of a vocabulary, or the loss of power to concatenate the exact sound with its appropriate idea, does not deprive the individual of all the power to do many things as well as he did them formerly. And it is difficult to see why, when that is the case, the individual thus affected should be deprived of any of the civil privileges he is capable of exercising; and there can be no possible reason why, in case of the commission of a crime, the individual suffering from aphasia should be held irresponsible. Of course in every case due precaution must be taken that the act is performed or the words used are understood as the individual who is exercising a civil privilege wishes them to be done or understood. Just as in an English court a foreigner who cannot speak the language can, by means of a sworn interpreter, give evidence, so we would be inclined, after medical evidence had been heard as to the competency of the witness, to allow a person labouring under aphasia, by means of a sworn interpreter who understood the words or gestures of the patient, to bear testimony; and so with regard to all acts, such as contracts and testamentary acts, where by means of competent witnesses it is proved that the individual had the capacity as it is defined in another part of this work; and by witnesses on oath or LANE MEDICAL LIBRARY STANFORD UNIVERSITY STANFORD, CALIF. 94305 by affidavit, that the inappropriate words or gestures were properly interpreted at the time of the execution of the will or of the agreement of the contract, we would hold that the latter was binding and that the former was a good will. In every civil matter in which the possession of speech is not absolutely necessary we would, after similar precautions had been taken to ascertain the state of mind of the individual and his desires in the matter, allow to a person affected with this marked condition the exercise of every privilege and the enjoyment of every right. With regard to the criminal responsibility of persons labouring under aphasia nothing requires to be said. It is evident that, if a man is in a position to enjoy privileges and rights, he is in a position to respect those of others; at least, that is true in cases of aphasia. CHAPTER XVI. ON ACUTE DELIRIOUS MANIA. It is a matter of much importance to a medical jurist to be able to distinguish between mania and maniacal delirium. We have seen that all insanity is due either to a functional or organic change in the nervous centres, but there is a kind of insanity which is called delirium which is due to an acute disease either in the brain itself or in some organ with which it sympathises. In the latter case the insanity is, as it were, grafted upon the bodily disease; in the former case it is a disease in itself. These two diseases not only differ in their origin, but the progress of each is very unlike that of the other. The prognosis is, of course, dependent upon these two things, the cause and the course, and it would be somewhat extraordinary if we found those widely different while the termination was the same. The difference begins almost before the disease can be said to have commenced. The premonitory symptoms in cases of acute delirious mania are seldom well marked; indeed, instead of the patient feeling that there is something wrong for weeks and months, as is not unfrequently the case in the early stages of mania proper, the individual may awake from sleep delirious. It is, perhaps, more generally manifested in the first instance by muttering or talking during sleep, and by a want of recollection and recognition of the persons and things about him when he wakens from dreams. So it is we see that waking state, sanity, pass into that dream frenzy mania. In the earlier stages of the disease, however, this want of power of recognition is only transitory, and the patient when fully aroused is conscious of his position and surroundings. Soon, however, reveries become embodied as it were. The patient lies and mutters for hours together, he is no longer capable of recognising persons who are |