1879 Jackson on Affection of Speech From Disease of the Brain 3

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ON AFFECTIONS OF SPEECH FROM DISEASE OFTHE BRAIN.

BY J. HUGHLINGS-JACKSON, M.D., F.R.O.P., F.B.8.,

Physician to the London Sotpital, and to the National Eotpital for the Epileptic

and Paralyted.

IT will doubtless have struck all physicians as strange thatSpeechless patients should have such recurring utterances asjargon No. 1 (Vol. II. p. 205), or single words, No. 2 (Yol. II.p. 205), or, what is most strik ing , such as " I'm very well,"" Come on to me," No. 3 (Vol. II. p. 208).

It may perhaps be well to give some examples of theseseveral kinds of recurring utterances from Trousseau's admir-able Lec ture on Aphasia. (I take them from Bazire's transla-tion for the New Sydenham Society, adopting his renderinginto English of the utterances of real words from the French ;some of the utterances were jargon.) One patient could utte rno thing whatever else than " O h! how annoying !" Trousseau

says of this pat ie n t: " Although she loo"ked in telligen t andbehaved like a sensible person, I could never obtain anotherword from her." Another pa tient u ttered, " Vousi, vousi."Another at first could only utte r "Monom entif " ; later on afew monosyllables ended by "tif," or the first syllable of aword and " tif," instead of the second, as " montif," for mon-sieur. Another uttered " P ig , animal, stupid fool," and th a talone. Another, "N asi bousi, nasi bousi." Another, "M y

faith !" Another patien t, " Cousisi, cousisL" (This patient,by the way, had the occasional u tterance when very excited,"Sacon, sacon," which Trousseau supposed to be an abbre-viation of " Sacr6 nom de Dieu.") Another, only " Oh ! mad."Another, " Sacr6 nom de Dieu."

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Brain: A Journal of Neurology, volume 2(3), 1879, pp. 323-356.

Part Three

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3 2 4 ON AFFECTIONS OF SPEECH

It will have occurred to the reader that these utterances arenot in th e same category as " yes " and " no ," in regard to the

hypothesis stated, VoL I I . p. 215. W e cannot say th at the

cases in which they remain show a reduction to the mostgenera l of all propositions. Some of the utterances of groupNo. 3 are propositional in form, but yet not of use as proposi-

tions to the speechless man; they are to him not propositions

at all; figuratively speaking, they are propositions intel-lectually dead; they serve only emotionally, and in that way

subsidiarily, as a sort of articulatory material on which thevoice may vary. " Y e s" and " No," group No. 4, Vol. II.

p. 209, also are occasionally from the mouth of the speechlessman, intellectually dead (See No. 4 (a), Vol. II. p. 210), and

serve only emotionally; nevertheless these utterances so

serving are in a different category from those of group 3.We have even on this basis to ask, "How is it that some

speechless patients retain an utterance of no propositionalvalue to them, but one which to healthy people is a propo-

sition of a special character, applying to a particular com-

bination of circumstances, whilst other aphasics retain anutterance of no propositional value to them, but one which

to healthy people is of propositional value of the most general

character, applying to any combination of circumstances ?" Of

contse (see VoL H. p. 209) the utterance may be an elaborate(compound) interjection, as " Oh, my God I" bu t we prefer

considering those utterances which in health are propositional.

The problem may be presented in one case. A patien t has" yes " and " no," and has also some elaborate recurring utter-

ance in propositional form. Supposing his " yes " and " no "to be utterable only emotionally (see No. 4 (a), Vol. II.

p. 210), we may say that he has two intellectually deadpropositions, one of a highly special kind, another of a very

general kind.

We wish in this instalment to show that the retention

of recurring utterances , other than " yes " and " no," althoughapparently is not really exceptional to the principle of Dis-solution. In all cases of Dissolution th ere is supposed to be

a reduction to the more automatic, more organised, to the

earlier acquired of the processes, represented in the centres


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PROM DTSEASE OF THE BRAIN. 325

affected. I t is, I think, plain that this course is in some casesapparently irregular. There are conditions interfering withwhat we may designate the Simple Course of Dissolution.

1

Let me illustrate this by a case from another class of nervousaffections. Just after a slight epileptic seizure there isDissolution, which in this case is temporary loss of function ofmore or fewer of the highest of all nervous arrangements; thepatient acts grotesquely; but his actions (occurring duringenergising of nervous arrangements next lower than thosewhich have undergone Dissolution) are not always rangeableas being more organised, & c, than his usual do ings; sometimes

they are plainly largely determined by particular eventshappening just before the seizure—that is to say, there areconditions interfering.

The matter to be discussed is not of scientific importanceas bearing on the Principle of D issolution. The discussionwill help us, I think, to clearer notions on the nature ofDefects of Speech (our No. 1, see Vol. I. p. 314). W ere re-curring utterances alone in question it would not be worth

a physician's while to consider them at much leng th. W eshall in the next instalment consider other kinds of nervousdisease in which we find phenomena analogous to the recurringutterances of speechless patients.

The following hypothesis is advanced, and for the present isapplied to but one set of recurring u tterances, the groupNo. 3, Vol. I I . p. 208, and only to those of them which have

1Th e reader is asked again to observe tha t the term D issolution is u sed, as i t

is by H erb ert Spenoer, for n process whioh is th e reverse of Ev olutio n. I am

sometimes told th at it is not a fit term to apply to the results of disease on the

nervous syste m ; gra nting th at those results are t h e opposite of Evolution of th e

nervous system. I do not believe they can bo shown to be the exact correspond-

ing opposite. Even supposing that the te rm does not properly apply, I submit

th at it is inexpe dient to coin ano ther word for a process the reverse of Nerv ous

Ev olution , when Dissolution is already in use for the reverse of Evo lution in

gen eral. Affections of speech are exam ples of Dissolution occu rring in a subo rdi-

na te oerebral centre . Ins an ity, as for exa mp le the case of post-epileptic insanity

mentioned in the text, is Dissolution, beginning in the highest oerebral oentrea,

in those oentrea whioh are supposed to re-represent all that the subordinate

centres have already represented, and thu s, indirectly, to represent th e whole

organism; tho highest oontres are the substitute of our highest, latest, over

olianging mental states, the abstract nnme for which is consciousness, there being

really a serios of consciousnesses.


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326 ON AFFECTIONS OF SPEECH

in heal thy people preposit ional va lue. Such recurring utter-

ances as " Com e on to me" were being said, or rather were about

to be said, when the patient was taken ill. Here we have, i t is

suggested, a condition interfering with the simple course ofDissolution.

In order that we may show this hypothesis to be reasonable,the reader must bear vividly in mind that " taken i l l " meanshere the occurrence of damage in a region of but one half ofthe brain, the left usually, sufficiently extensive to cause lossof speech. H e must keep in mind tha t the nervous arrange-ments in this cerebral region are destroyed; it will not do to

think of the disease vaguely as something " disordering certainfunctions of the brain." And on the psychical side he mustlook on the condition as one of loss of the words used in speech.The expression loss of memory for words is too indefinite, or isonly verbally definite. I t is equally importan t for him to bearvividly in mind tha t the other half of the brain, the rig htusua lly, is not at all injured. H e is asked never to lose sightof the fact tha t, although the patie nt is rendered Speechless

by the disease, he is not thereby rendered Wordless. W emust indeed bear most vividly in mind that the patient has

words remaining ; it will not do to think of this positive con-dition under the vague expression tha t " lie retains a memoryof words." If we do use such redu ndant expressions, we m ustbe thorough in our application of them and say two things , (1)that the speechless patient has lost the memory of the words

serving in speech, and (2) that he has not lost the mem ory of

words serving in other ways. In healthy people every word isin duplicate. The "e xp erim en t" which disease brutallymakes on man seems to me to demonstrate this; it takes oneset of words away and leaves the o ther set. The speechlesspatient has lost that set of words which serves in speec h; heretains another set of words serving in other w ays; * he retains

1 Th e use of suoh high ly technical expressions as " me mo ry," in " exp la-

nation " of complex symptomatic) conditions, seemingly definite and authoritative,

is largely to blame for OUT rem aining with our ideas on nervou s diseases ont of

focna. I t is not alw ays vividly realised th at retention of memory of word s can

mean anything more than a retention of words , the word "m em or y" in that

context being really surplusage. The re is almost the idea tha t tho speaker gives

words to th e persons spoken t o ; a ll th e speaker does is to rouse words alread y


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FROM DISEASE OP THE BRAIN. 327

all the words of the (his) English language in so far as" receiving speech " of others goes; and for other purposes hehas lost the ir duplicates by which he should speak. I t issuggested that whilst the speechlessness answers to the damage

in one half of the brain, the retention of other kinds of serviceof words answers to the fact that the other half is not damaged.Attention is also asked to the hypothesis already stated, andhereafter to be expounded a t length , th at every propositionin health occurring during activity of the left side of the brainis preceded by a revival of the words of it during activity ofthe right half.

1This is stating the hypothesis roughly and

inadequately; all that need be insisted on is that the unit ofaction of the nervous system is double the unit of its com-position, and that, correspondingly, all mental action is dual;subjective followed by objective. But as roughly put thehypothesis will serve our present purpose, since the speechlesspatient has no left half of his brain so far as its use in wordsgoes.

Here brief remarks may be made on dual action in other

mental processes in order to make clear what is the nature ofthe dual service of words. If I do no t succeed in showingthat there is duality of mental operations and what is thenature of that duality, I shall fail to make clear my meaningas to the nature of Becurring U tterances and to in terpretmany other difficult parts of our subject. W e take for illus-trations Ideation and Percep tion ; tha t is to say, "propositionsof images," which are symbolised by propositions strictly so-

called. This is tru ly a part of our subject. I t is indeed anentirely arbitrary proceeding to separate the images symbo-

organised in the person spoken to. An y one will readily adm it tha t the pain

of a pin-prick is in himself, not in th e pin ; and every educated man adm its that

redne ss is in himself when he uses the ordinary lan gu ag e, " Th is briok is red."

W hy the n should we speak of " reten tion of momory of words " by the aphasio

when he understands what we say to him without, at any rate, using that expres-

sion as simply convertible w ith the expression t ha t he reta ins words (physically

organised nervous arrangements for words) ? Whose words are those whioh occurin the so-called he ari ng " voices " of the insane f

1There are then, it is supposed, two services of words by the right half of the

brain ; th e •' reception " of words of othe rs, and the reprod uction of words which

precede our own speech . The se are the two way s other th an spoech in which

words are supposed to genre. Doub tless at bottom these two are alik e.

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328 ON' AFFECTIONS OF SPEECH

lised from the symbols of images; in what we shall call the"c on flict" both are concerned. Nevertheless th e artificialseparation of them is convenient in brief exposition. I t willsuffice for illustration to take count of but one image, although

two images must be concerned in every ideational or per-ceptive process and also in the stage preceding ideation orperception (ideation may not be followed by perception, bu tideation must always precede perceptions).

It seems clear enough that the process which ends inideation or perception is dual. Before we can see or think of abrick, before either ideation or perception can occur, that brick

by actual presentation or by indirect presentation throu ghassociation, must have roused an image in us. W hen we saywe see a brick, all we mean is tha t we project into the en-vironment, ideal or actual, the image which that brick hasroused in us. Th is image arisen in us is the surv ival of thefittest image at the teHnination of a struggle •which the pre-sented brick has roused in us, is the end of the subjectivest ag e; the further stage, or the second stage, is objective—it

is referring the image already roused in us to the envi-ronment, actua l or ideal. The brick is for ua no thingmore than what it has itself roused in us, so that , instead ofusing such figures as th at " the m ind impresses its own lawson sensations" we experience during contact with, externalobjects, or " that th e mind originates something additiona l tothem ," or " works them up into different shapes ," or tha t it" impresses its own form on them," we should, I think, use the

opposite figure that an external object acts on us and de-velopes in us such as we are, what it can, we being at firstpassive and it active. I th ink it is plain ly so in dreamsexcited by peripheral local excitations. And in reverse,cracks and marks in the burning coals make us see faces inthe fire, rouse faces in us.

Returning to the dual service of words. If we coin the termverbalising to include the whole process of which speech isonly the end or second half, we may say tha t there are in ittwo propositions: the Subject-proposition followed by theObject-proposition, the la tte r being called speech. Spencerwrites (' Psychology,' vol. i. p. 162) : " A psychological propo-


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PROM DISEASE OP THE BRAIN. 829

sition is necessarily compounded of two propositions, of whichone concerns the subject and the other concerns the ob jec t;and cannot be expressed without the four term s which these

two propositions im ply." I t is supposed that the subject-proposition is the "surviv al of the fittest" words in fittestrelatipn during activity beginning in the right half of thebrain, and that this survival is at once the end of th e sub-jective and the beginning of the objective stage of verbalising.The subject-proposition symbolises an interna l relation of twoimages, internal in the sense that each of them is relatedto a ll other images already organised in us, and th us it

symbolises states of us; the object-proposition symbolisesrelation of these two images as for things in the environment,each of which images is related to all other images thenorganising from the environment; thus it stands for statesof the environment; the two propositions together symbolisean internal relation of images in relation to an externalrelation of images. Thus the separation we have made intospeech use of words and not-speech use of words may appear

arbitrary; it is, however, convenient.

In one of the cases to be presently mentioned in the text—th e pa tien t who said " Come on to me.." the re was left' hemi-plegia, and thus the inference is irresistible th at his speech-lessness was caused by damage in the right half of h is brain .Bu t as he was a left-handed man, his case is an exception provingthe ru le. I t is adm itted that there are cases of left hem iplegia

with aphasia in persons who are no t left-handed. Besidesgran ting fully the significance of the fact tha t in the vastlygreater number of cases loss of speech is caused by disease inthe left half of the brain, the thing of infinitely greatersignificance is that damage in but one half can producespeechlessness; it is equally significant that damage inneither half, produces wordlessness.

In a few cases I can state the circumstances of the onset ofthe illness, which seem to me to countenance the hypothesisstated. The man whose recurring utterance was " Come onto me," and sometimes only " Come on," was a railway signal-man, and was taken ill on the ra ils in front of his box. Awoman in G uy's Hospital could only utte r " Gee gee " ; she


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was taken ill whilst rid ing on a do nkey. Dr. Russell ofBirmingham has published the case of a clerk, who lostspeech and became paralysed on one side, after hard work in

making a catalogue; this poor fellow could only say, "Listcomplete." Sir Jam es Pag et a few years ago had under hiscare in St. Bartholomew's Hospital a man whose left cerebralhemisphere was injured in a brawl. This man could only say," I want protection."

The hypothesis further unfolded but applied only to theabove-mentioned cases for the present, is that the words of therecurring utterance had been revived during activity of the

right half of the brain, when the destruction of that partof the left half occurred which caused loss of speech, that theyconstituted the last proposition, or rather that stage of verbalrevival (what we have called the subject-proposition), prior tothe last proposition (the object-proposition). Ev er after they

were meaningless or, figuratively speaking, dead propositions,remaining utterances of which we can only say they were onone occasion speech; on that occasion fitted to indicate thenoccurring relations of th ings. On the rails, or certa inly atsome junc ture, " Come on to m e " meant " Come on to me,"

ever after the illness it meant nothing.

The expression "on one occasion" is not to be taken

literally as m eaning th a t; for example, the man who uttered" Come on to me " never said tha t before he was taken ill onthe rails. The presumption is tha t he had said it on many

occasions, when trains were approach ing his post. W ha t Imean rather is, speaking now of the healthy, that there is no

such proposition in a man's mind, excepting when he is sayingi t On the physical side we would suggest tha t the nervousarrangements concerned during the utterance of any such pro-position are not excited, nor ready to be excited, in the par-ticular order answering to such proposition except at the time

of utte ring it. Such propositions are new speech. The " same "

proposition is new or " la te s t" speech each time i t is uttered ,if the words or syllables of it are not, so to speak, " kep tready made up " in that particular com bination; at any rateit is "latest speech" when specially applied at a particular

time to indicate then occurring relations of things which are


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FROM DISEASE OF THE BRAIN. 331

not fully organised ; it is then, otherwise stated , a voluntaryuse of words.1

From the most automatic or " olde st" or " ea rlie st" speech,

app lying to well-organised exte rna l relations of th ings up tonewest speech, app lying to now organising, exte rnal rela-tions, or otherwise put propositions now in the making, thereare, it is supposed, on the physical side, only degrees of inde-pendency of organisation in the Bense that the nervous centresconcerned have lines of different degrees of resistance tocurren ts of different force, en tering the centres at differentpoints. Other things equal, the more autom atically serving

(the more organised) nervous arrangements are lines of leastresistance. There is, however, in the case of very frequentlyused and very autom atic utterances, such as " Very w ell," " Idon't know," a near approach to independent organisation,and in the case of the most common interjections a very nearapproach to it. Such utterances constitute what I call oldspeech, or, in the case of interjections, th ey are verbal pro-cesses lower and earlier than true speech—utterances not" now

m aking ," bu t nearly, if indeed not quite, " ready made up ."And at the other extreme, in the highest, newest, or latestspeech, there remains for a short tim e after the utterance aslight degree of independent organisation of the nervousarrangements concerned; did there not, we should not knowwhat we had just said, and could not go on talking conse-cutively on any subject. If this reasoning be correct, such a

1 The very same " utteranoe " which has become automatio by being often usedfor symbolising frequently presented, and therefore well organised, external rela-

tions of things would be once more a voluntary utterance, if it were used on a

new occasion, that is for sym bolising a re lation of th ing s not already organised,

but only now organising. Th e " highest," " latest," or " newest," speech (the

now organising or voluntary UBe of words), implies clear p reoon ception ; clear

preconception i s a neoessary element far voluntary, as distinguished from auto-

matic, operations; in voluntary speech the prior reproduction of words constitutes

the preconception. If a mau utters, as app lying to a new set of oiroumstanoee,

the most automatic utteranoe he has , or if h e utters any thing " for the sake of

uttering it," as wh en asked to do so, there Is then a voluntary utteranoe, for thenthe operation occurs after clear preconoeption. Disease show s th is not to be a

fanciful dictum. A« we have seen, and we shall later on give further examples,

a speechless patient may be u nable to toy (to repeat) what he has ju st uttered.

We do not affirm that the word "s a y " in th is context means a languag e

process.

V O L . I I Z


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recurring utterance as " Come on to me " represents not onlythe last proposition en permanence, but is to be looted on ason the physical side, a keeping up of activity (of a greate r

readiness to discharge), of certain nervous arrangements, whichnormally exist only temporarily and only on special occasions,in particular combination, and which in health go quicklyinto subordinate function, and soon out of function.

1

Such a recurring utterance as "C om e on to m e " wasabont to be new speech; the words remained en permanenceas a dead propo sition; a proposition stillborn. W e con nowdescribe the case of a man who has the two Sets of recurring

utterance as that of a patient retaining a new combinationof words, and also an old combination—or rather in the lattertwo monosyllables, each of whieh is equivalent to a combinationof words.

The reason for thinking that the recurring utterances underremark were and continued to be utterances occurring duringactivity of the right half of the brain, is that the left half ofthe brain is so extensively damaged that the patien t cannotspeak ; he has no left half for their utteran ce. To say th atthe disease " caused " these utterances a positive condition isabsurd, for the disease is destruction of nervous arrangements,and tha t could not cause a man to do som ethin g; it hasenough to answer for in leaving him unable to speak. Theutterances are effected during activity of nervous arrange-ments which have escaped injury. This remark may seem a

truism here, but in more complicated cases it is very commonto hear of positive symptoms being ascribed to negativelesions— to loss of function of nervous elem ents. (See p . 316,Vol. I., On Negative and Positive E lements in Sym ptomaticConditions.) I t is common at any rate for disease to bethought of vaguely as something "disordering the functionsof the bra in." In the cases we are now dealing with, and incases of defect of speech, and also in cases of insanity, the

function of some nervous arrangements is lost or is defective.

1Praotioally out of fimotion, so far as out p resent subject is concerned, although,

obviously, there would be DO new acquirements possible, and no memory, if some

nerroat arrangements after their use did not remain lines of lea* resistance than

before.


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FEOM DISEASE OF THE BRAIN. 333

But it is an error to ascribe such positive symptoms as therecurring utterances in speechless men, the erroneous wordsuttered by those who have defect of speech, and the halluci-

nations, &c, of insane persons, to negative lesions—to loss orto defect of functions. These positive mental symptoms ariseduring activity of lower centres or lower nervous arrange-ments which have escaped injury, and are only to be thoughtof as symptoms in the sense of being the fittest psychicalstates arising during slightly hyper-normal discharges of loweror more organised nervous arrangements which are thenhighest, the normally highest having lost functions.

It might be suggested that not all, but only nearly all, thesubstrata of speech were destroyed, and that enough nervousarrangem ents remained in th e left half for just one utterance.Since, as implied in a foregoing statem ent, I do not believethat words or syllables have nervous arrangements in thesense that there is one little nervous centre for each syllableor rather single articulation,1 and for no other, and since

too I believe that each unit of every nervous centre is thewhole of that nervous centre in (different) miniature, Ishould be as ready as most people to accept this explanation.But a certain quantity of nervous arrangem ents, implying acertain quantity of energy, is required for every operation.As the R ecurring U tterance is, as a series of articulations,very elaborate, and as the syllables are c learly enunciated atany time, it is not credible tha t slight remains of nervous

arrangements can be concerned during the utterance of them,especially when looking at the m atter on another side we seethat these remains do not serve the patient to utter any otherwords whatever, except perhaps " yes " and " no," which I how-ever believe to occur also during activity of the right half ofthe brain. The man who uttered " Come on to me " uttered itany time, with no effort, rapidly, and in fact just as well as a

1 The reader will observe that nothing 1B said in the text which implies that aword if a nervons arrangement resenting an artk ula tory movement. All tha t is

sugge sted (see Vol. I. pp. 305,806) is th at the anaiomioal tttbttratum of a word is a

nervous arrangem ent representing one or more particular articulatory movements.

Th e reader will observe, too, th at we sometimes speak of words, and a t other

times of their physioal bales, but we do not, it is hoped, confuse the two different

things.


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hea lthy person could utter i t ; ye t except for this and " yes "

and " no," he could utter nothing else. It is submitted that it

is not possible that such an utterance was effected during dis-

charges of remains of a nervous centre so extensively diseased,that is to say, not during discharges of any part of a half of

the brain which was damaged so much as to cause speechless-

ness. It is more likely to be uttered during activity of the

undamaged half.

We repeat, the patient may have not only such a recurring

utterance as " Come on to m e," but he may have also the

utterance " yes " or " no," or he may have both these words.

W e have endeavoured to explain the retention of " yes " and" no," p. 214, by saying that the patient is reduced to the two

most automatic, the two most organised, of all propositions.

We have tried to show that in a sense the principle of disso-

lution is not contradicted by the retention of the elaborate

recurring utterances under remark. There are, we have sug-

gested, conditions interfering with what we may call the

simple course of dissolution. The patient retains not only

his most automatic propositions, but his last proposition, the

then most voluntary proposition; the former sometimes, the

latter always, ceasing to be propositions.

Let us now look more particularly at the anatomico-physio-

logical side; t ha t is, examine the utterance from the side of

degree of organisation of nervous arrangem ents. W e must

bear in mind that, to speak metaphorically, all disease cares

about is degree of organisation ; it respects processes the morethey are organised, caring nothing about important or unim-

portant. A t present we can only sp ea t in outline.

In estim ating organisation in its bearing on affections of

speech or on any other sort of defects from nervous lesions, we

have to consider recency of organisation, as well as degree of

organisation. I t is well known that in failing memory recen t

events are soon forgotten, w hilst old events are remem bered; bu t

this is not without qualification; the most recent events areremembered as well as the old; on the physical side, nervous

arrangements just discharged remain for a short time in a

state of slight independent organisation, rivalling that of

nervous arrangements discharged when the person was young


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and vigorous, or that of nervous arrangements often dis-charged.

That the nervous arrangem ents for the words of the recurring

utterance (No. 3) are parts of the pa tient is a t ru ism ; tha tthe words must one time have been revived in propositionalform, tha t certain nervous arrangem ents m ust one time havebeen discharged in a particular order, is another. The hypo-thesis that the words were being revived at the time when thepa tien t was taken ill seems to me w arrantable. As they re-main always easily utterable, and they alone utterable, sincethe illness, it is plain that certain nervous arrangements which

were being discharged when the pa tien t was taken ill, orat any rate which were on some occasion being discharged in aparticular definite order, remain permanently in a state of dis-chargeab ility far above norm al. For the patient not only doesno t speak since his illness, but whenever since his illness he triesto speak, th e recurring utterance comes out or nothing comeso u t Note three equally important things—(1) he has it ; (2)he has no other utterance (except perhaps " yes " and " no " ) ;(3) he cannot ge t rid of it. I t is certain tha t the nervousarrangem ents for the recurf ing utterance have somehow arrivedat what is in effect a high degree of independence of organisa-tion. We can say, if the hypothesis pu t forward be true , thatthe nervous arrangements for the proposition just organising atthe time of the illness, those for th e words last spoken or aboutto be spoken, remain as well as the most and always organised

nervous arrangements for the most automatic propositions, andhave somehow achieved a degree of independent organisationgreater than tha t of any other word-processes except " yes " and" no "; probably by repeated utterance after their first u tterance.On this matter we shall speak later, when considering thephenomenon called by Gairdiner " barrel-organism." A t pre-sent the explanation given may seem to be merely a verbal one.W e may consider part of the question at once. Repeating that

the patient has the utterance, and that he cannot get rid of it,we restate the question thus. How is it, (1) tha t destruction ofone centre (certain part of the left half of the brain) leavesin state of hypernormal dischargeability particular nervousarrangements discharging in another centre at the outset


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of the illness, right half of brain, a lower centre ? and (2) Howis it th at they do not go out of function, as they certainly wouldhave done had not that destruction occurred ? We say again

that the destruction in the left half is not the cause of therecurring utterance; a negative state of nervous elements can-not possibly be the cause of positive nervous symptoms. Noris destruction of some nervous arrangements the cause, or atany rate not th e direct cause, of certain other nervous arrange-ments discharging and remaining in a state of hypernprmaldischargeab ility. But plain ly, if the man had not been " takenill," he would not have had such a recurring utterance; he

would have been able not to niter it, the nervous arrangementsconcerned would have gone out of function; but since his ill-ness, he must utter it when he tries to speak, if he uttersanyth ing . I believe the solution of the seeming paradox tolie in this, that destruction of function of a higher centre is aremoval of inhibition over a lower centre (' Princ iple of Lossof Control,' Anstie, Thompson Dickson), the lower1 centrebecomes more easily dischargeable, or popularly speaking

"m or e excitable," and especially those parts of tha t centrewhich are in activity when control is removed. So to speak,these, parts become autonomous, acting for themselves, ju st asparts of the spinal cord below a diseased point become autono-mous in some cases of paraplegia. Thus the disease causes lossof speech ; it permits the increased dischargeability of the righthalf. It is just as cutting the pneumogastric does not cause,bu t perm its, increased frequency of cardiac beats. But, the

simple course of dissolution being interfered with in the casesof speechlessness we are writing about, the activity of thecentre manifests itself in the way it was temporarily in whencontrol was removed. The greater excitability of a centreuncontrolled by removal of its h igher centre is supposed tobe temporary, but the particular activity may be kept upby repeated use; the speechless man's recurring utterance isbeing uttered very often; it keeps up what was doubtless atfirst a temporary organisation.

1 Of oon ne we do not m ean geogra phically lower, bu t physiologically lower,more organic, Ac., and, in tome instances, the centre which a ct* before th e oneoi led higher .


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W e must be very careful how we use th e word " cause "with regard to disease and symptoms. W e m ust never speakof destructive lesions causing positive symptoms. I t • is

erroneous, I submit, to say that any sort of disease causeselaborate positive mental symptoms—illusions, hallucinations,&c.—it causes a negative mental condition, the elaborate posi-tive mental symptoms are permitted. Here again we see thecrudity of the expression " disease disorders th e function ofthe brain "; destructive lesions cause loss of function of somenervous arrangem ents, and thereby over-function of others ispermitted. Another way of pu tting this is to say that th e

effects of Dissolution are not always, never I suppose, simplythose of removal of the more special, voluntary, and least andlatest organised, but are-very often also a permitted increasedactiv ity of" the nex t most special, volun tary, and next leastorganised. Thus in every case of insanity there are twodiametrically opposite symptomatic mental states together,and there must be correspondingly the opposite physicalconditions together.

In some cases there Is the utterance of " yes " or " no," orof both, without any other recurring phrase. This would beexplained on the supposition that the patient was not saying,nor about to say, any thing when tak en ill, and thu s th at therewere no words being revived, no proposition organising, duringactiv ity of th e right side of the brain . Thus there was, so tospeak, nothing to interfere with the simple course of dissolu-

tion, reduction to the most automatic of all propositions.I t iB to be clearly understood that in not one of th e casesdo I know what the patients were saying, or about to say, atth e time of their attack . I must also mention tha t there areobservations on record which perhaps run counter to thehypothesis. Thus a man, aged 21, suddenly called out to hismother, " Oh I I feel something extraordinary inside me."These were the last words he spoke, bu t his recurring utte r-

ances were " No " and " Mamma." Very like ly, however, ca ll-ing out to his mother, he would also have cried " Mamma."

1

1I take th is case from a lecture by Trousseau ; the utterances were in French

but I give them as translated by Bazire.



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I must also declare that of other cases than thoseexpressly mentioned, I know nothing at all of particularcircumstances during the onset of the ailment, which could

be supposed to have given rise to speech like the re-curring utterances the patien ts had. I have no facts tobring forward to show what were th e particu lar circum-

stances during the onset of the illness of the patientswhose recurring utterances were severally " man," " one,""awful," "Y es, but you know," " I 'm very Avell," &c. A tfirst glance it seems unlikely tha t a patient should say," I'm very well," at the time she was taken i l l ; but as a

matter of fact, people becoming ill do make such remarks.Who has not heard a person say, when a little ill, or whena severe illness was beginning , " I'm all right, let me alone,"perhaps adding the contradictory statement, " I shall be betterdirectly " ?

W e must bear in m ind th at when people are not talkin gthey may be speaking; for there is not only external, there isalso internal, speech.1

Whilst thinking on anything, at least beyond the simplest,

we are using words, and when th ink ing on anyth ing complex,are speaking intern ally. Bu t I do not see how we are toverify the hypothesis that a patient's recurring utterance wasa survival en permanence of the words he was internally using,

1The reader will remember that the distinction into internal and external

speech (only a difference of degree) is not (see p. 818, VoL I.) tha t made into the

two kinds of service of words—the subjective and objective. There are degreesof each kind. The subjective, at any rate in that part of i t which is " receivingspeech " of others, is plainly in degrees; we hear and " receive ** what people areactually saying, we also remember what they have said, which is having again,faintly, the words in ourselves which their speech had revived strongly. Itmust never be forgotten that when we hear and understand what any one says tous, we can only do so because our own words are revived in us ; if I have not thewords " gold," " is," " yellow " organised in mystlf, it is of no use any onesaying "go ld is yellow " to me. Similarly the objective is in two degrees;there is both internal and external speech, corresponding to ideation and pvr-oeption. Speech in either of these degrees is supposed to be preceded by anautomatic and subconscious reproduction of words (by a subjective proposition),just as either "i n te rn al " perception (ideation) or "ex terna l" ideation (perception)is preceded by a subconscious and automatic reproduction of images. It is notmeant that, either betwixt ideation and perception, or betwixt internal andexternal speech there are differences only in simple degree; the degrees ore,I think, triply compound.


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unless perhaps the circumstances and the condition of thepatient are known very exactly.

We have to consider how the hypothesis applies to the

recurring utterances, No. 1 and No. 2. How is it th at thereis (except perhaps " yes " and " no ") jargon only, or bu t oneword on ly? Th e difficulty is greatest with regard to th ejargon (No. 1), and this I shall chiefly consider. I believe thejargon to be made up of fragments of the words or phrasesthe patient was about to utter when taken ill.

I t is, I gran t, a mere guess tha t a speechless woman, whoserecurring utterance (I spell it from the sound) was "me,"

" m e," " pittym y," " com mittym y," " lor," " deah," was saying ,when she was taken ill, " P ity me," " Come, pity me,"" Lord," '' Dear "— that her recurring jargon-utterance repre-sented what was part of the verbal revival prior to her lastprepositional or interjectional utteran ce, that it was a corrup-tion of syllables of some of the words which were beingrevived dur ing activity in the right half of her brain, whendestruction in the left half produced loss of her speech. There

is a greater difficulty in supposing that such a jargon-utter-auce as " yabby ," resembling no En glish word, was m ade upof fragments of words which were being revived during activ ityof the right half of the brain, when the patient was taken ilLTo say that " yabby " was a jumble of syllables of some wordsabout to be uttered will appear to be carrying the hypothesisto its logical conclusion with more determination than caution.

Let us pause to remark on occasional temporary jargon,and on something approaching to it, in other aphasic cases.Some patients, who have only defect of speech, and whoseerroneous utterances are nearly always real wordB, may occa-sionally utte r " jargo n," as "to tan o." I confess tha t I amunable to trace the steps of the formation of such jargon.Occasionally there is a very near approach to a transpositionof syllables of a word. One of my patients said " gippin "

for " pigeon." There is ano ther kin d of change : one of mypatients said " lamb and crobster " for " crab and lobster."There is here a fusion of the first syllable of the second wordwith part of th at of the first, or rath er, perhaps, speaking ofthe physical side, a result of attempts at two articulations.



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Such blunders occur, I think, in persons whose speech is onlyvery s lightly defective : I mean in those who, for the mostpart, speak well. The following occurred in hea lthy peop le:

"mukes from Boodie's," for "books from Mudie's"; "get acash chequed," for " ge t a cheque cashed." A similar thingoccurs in writing, as " Mear Dadam ," for " Dear Madam " ;" pred budding " for " bread pud ding ." (This is interesting,as showing that erpression by writing is really speech.) Ibelieve that these troubles of speech are owing to hurry onthe right half of the brain, to hurried reproduction of thewords of the subject-proposition. Believing th at images and

words are subjectively revived in an order the reverse of thatin which images and words are finally arranged, I suppose,speaking roughly, that the words of the subject-proposition" come ov er" to the left side prem aturely. These utterancesare jargon, the sources of which we can trace, in so far, Imean, as fusion of an initial syllable of a second word withth at of a first word goes. And I believe th is to resu lt fromhurried action in patients who have defect of speech, partly

for the reason that such and similar mistakes occur when apatient replies at once to questions abruptly put to him, andbecause when not hurried, when not " taken sudden ly," hemay speak for the most part welL

W e can now return to consider more easily the permanentrecurring jargon of patien ts who are speechless. W e speakof what is supposed to have occurred in the right half of

the brain, when the speechless patient was uttering, or aboutto utter, his last proposition. If the reader does not gowith me in supposing that the right half of the brain isconcerned, he must, at any rate, believe it is some part otherthan th at on th e left which the disease destroyed. I t issuggested that when the recurring utterance is in clear propo-sitional form, such as " Come on to me," the rig ht half of thebrain was acting normally or usually; that when it is a single

word or jargon, it was acting abnormally, being "hurried."W hat is the cause of this hurry ? I believe it to be strongemotion. A t the tim e of the onset of the illness, we maysuppose strong emotion would be induced by the externalcircumstances, or much more probably by the setting in of the


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FBOM DISEASE OP THE BRAIN.

illness, the pa tien t being afraid of worse to come. Here , ofcourse, a knowledge of the patient's temperament is veryimportant. The patien t who uttered " me," " me," " pittym y,"

" committymy," " lor," " deah," was, to my own observation, amost excitable woman. Her husband used to remark on this .He said she was fond of sensation tales: she would any timego out in the night to a fire. Strong, especially suddenlyinduced, emotion implies, on the physical side, great nervousexcitation, that is to say, strong, wide, and sudden discharges;there will, under strong emotion, be more rapid and morenumerous, and therefore conflicting, discharges of nervous

centres. In the cases under remark we consider the resu lt ofdischarges on centres for words.

The result of num erous sudden, strong, and therefore con-flicting discharges, would of course be the survival of the fittest,bu t the survival amidst too numerous and too strong dischargeswould not be an elaborate and perfect proposition. W esuggest that it would be but one word or a jumble of syllables

of some words. Of course " fittes t" here does no t mean " th ebest," nor the fittest for the external circumstances of the time;it is the survival of the fittest under the internal circum-stances.

1The fittest words or syllables are the victorious

1 The words and images whioh survive during healthy discharges are survivals

of the fittest. So it is in disease. Th e images that survive in delirium are the

then fittest, considering that some of the high est nervous arrangements are hort

da combat. Th e delirious patient is n ot the same person as tha t patient before

his delirium set in ; the delirious patient is the sane man mintu more or fewer of

his h ighest nervous arrangements ; his delirium is the fittest mentation then pos-

sible. In all cases it is supposed that wh at beoomes oonsdous is what survives

at the end of a conflict; the conflict is almost at lero in hig hly organised

processes, such as those for recognising very simple and very often seen things ;

in these cases consciousness is almost at lero too. In movement of any part of

the body there i s not only co-operation, but antagonism also of m uscles or

muscular strands (Duchenne uses the expression " cooperation of antagonism ").

The antagonist pulla—those against the direction of the displacement to be

effected—may be symbolised as minus quantities; the pulls oo-operating in that

direction as plus qu antities. A movement is then not the arithmetical sum ofpulls of all the muscles engaged , but the algebraical sum of the pulls. Trans-

ferring these ideas to antagonistic anil oo-operating discharges of nervous centres,

we may suppose that w hat we have called, both for hea lth and disease, the sur-

vival of the fittest during a conflict of numerous nervous discharges is the

algebraical sum of what on the physical side are oo-operating and neutralising

dischargee during the conflict


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words or syllables which have survived during a conflict ofvery strong and sudden discharges beginning deeply in thenervous system, and ending, so far as we are now concerned,

in that of many nervous arrangem ents for many words. Suchsurvivals may be little fit or not fit at all to the then externalcircumstances; they express the emotions and ideas inducedwell or badly, as well as it can be done under the cir-cumstances.

It is supposed that jargon is a survival of some of thesyllables or articulations more or less fused during the suddentermination or arrest of a strong conflict of discharges of

numerous nervous arrangem ents for different words. I t is apopular doctrine that strong emotion leads to incoherentutterances, which, I suppose, means the survival of wordssymbolising more than one different set of ideas. Strong andsuddenly induced emotion may lead to temporary speechless-ness. We suppose that temporary speechlessness with greatemotion betokens very numerous and strong nervous dis-charges, conflicting so as to balance or neutralise one another.1

In some other cases of disease psychical states cease duringsudden excessive discharges. An illustration is that d uringsudden and strong discharges, epileptic discharges, beginning.in the very highest nervous arrangements (consciousness), thesubstrata of consciousness cease.

We now consider the recurring utterance of one word (No. 2,Vol. I I . p. 205). Let us first note what occurs in hea lth.

Very often under strong and sudden emotion, a normal orusual degree of speech is not possible; some inferior speech ispossible. W hen there is not incoherence, bu t one word may beuttered or ra ther exclaimed, as " fire 1" " help 1" the utteranceis indeed often a very simple interjection, as " oh." One word,as "fire!" might in normal circumstances be propositionalonly or so practica lly; it m ight mean "there is a fire," butexclaimed under strong emotion it is also largely of inter-jectional value. Strong emotion leads to inferior speech, to

1Probably there is ft more complex condition ; duriug strong emotion, there

are rapid and strong dischargee on the vital organs which soon lead to oxhnustion

of these o rg an s; thus there will be a mu ltiplication of effects; the cerebrum,

especially it» highest, centres, will bo ill gorved with blood.


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more automatic, more organised utterance. Fig ura tivelyspeaking, emotion uses propositions in a largely interjectionalmanner, that is to say, it reduces them to or towards inferior

speech. Em otion, as it were, still speak ing figuratively, ap-propriates and subordinates an intellectual utterance . Thereis at any rate an interjection in the making, in the exclama-tion " fire!" " help !" & c, a degradation of speech (compareswearing). W e see in the utterance itself, that with a fall inthe intellectual element there is a rise in the emotional one.There may be an equal, no doubt a greater, liberation of energyduring these utterances, but it is directed more strongly on

the vocal (including respiratory) organs, to those organs whichserve especially during emotions. Strong emotion tends tomore automatic, inferior, utterance.

I suppose then that strong emotion, or rather, of course, thenervous discharges accompanying it, may have led in the

• becoming speechless man to so rap id a discharge of so manynervous arrangem ents of higher cerebral centres in th is casefor words, that in the great struggle resulting, the survival ofthe fittest was a survival, not of .the best for the then externalcircumstances, bu t of but one word, or of some syllable orsyllables; the fittest was then an interjection, or only someparts of sentences or pa rts of words fused into jargon.

Eap idity of emotion is the great thin g in the above consi-derations. In another way we are concerned with rapidity—with rapidity of the being taken ill, which means rapidity

of destruction of nervous arrangements in the left half of thebrain.

In all cases of nervous disease we must endeavour to estimatemost carefully the element of rapidity of lesions, not only thequan tity of nervous elements destroyed, but the rap idity oftheir destruction. W e have to try to estimate the Momentumof Lesions. W e however use the term gravity of lesions. Ido not pretend that I can show the bearing of the factor

rapidity on symptomatic conditions in cases of Affections ofSpeech. I t is fair, however, to consider it in this regard tosuggest a basis for future investigation . The slowness withwhich a lesion comes on is determined by the slow onset of thesymptomatic conditions; a small sudden haemorrhage produces


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greater but a more temporary effect, provided it does not atonce ki ll, than a large, slowly developed softening. Butin the latter the paralysis or other defect depending on

mere destruction of the centre is more local and more lasting.A very sudden grave lesion would render unavailing all

external circumstances, and would prevent all emotion, forit would produce unconsciousness at once; a less graveone would prevent the influence of external circumstances,bu t would develope emotion. A lesion of very lit tle gravitywould allow external circumstances to act, but to act quietlyand allow clear propositions to be framed. Repeat ing in

effect what has been said, it does not follow that the lesion inthe latter case is not an extensive on e; the question we a renow about is as to the gravity of lesions, metaphoricallyspeaking mv of lesions.

We should then note whether the aphasia and hemiplegiaare rapidly produced, whether or not there be sudden lossof consciousness, and note also the length of the coma, if

the re be any . Everybody does this for clinical purposes, inorder to obtain empirical evidence of the kind of pathologicalprocess, whether it be clot softening, & c.; bu t we should usethe facts also as regards the interpretation of the kind ofrecurring utterance the patient ^nay have. Perhaps the bearingof rapidity of destruction on the nature-bf recurring utterancesis not made evident in the above. I t is not here directly

a question of rapidity of destruction of any centre, or of

" shoc ks" given to centres connected by fibres with the onesuddenly damaged, but a question of the indirect effect ofrapidity of destruction, of such destruction in so far as itis a sudden removal of control (or inhibition) over lowercentres. Of course by " lower ce n tr e" we do not mean onegeographically lower, but one anatomically and physiologic-ally lower. The destruction can only directly oause negativesym ptom s; it neither directly causes the utterance nor

interferes with i t ; it may be popularly said to cause it andto affect it indirectly , bu t it is better to say it perm its it .In- so far as cases of aphasia are concerned, the above is hypo-thetic al. Le t us consider the principle stated more generally.In other cases of nervous disease rapidity of dissolution is, I


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PROM DISEASE OF THE BRAIN. 345

think , evidently an important factor with regard to sympto-matic conditions. The ep ileptic m aniac is the moat furious ofall maniacs. W hy most furious ? The fury is the psychical

side of what is physically of course great activity of nervousarrangements; it is activity of lower nervous arrangements;for as th e furious maniac is insensible also, it is plainthat his highest nervous arrangements are hora de combat.W hy then are th e lower nervous arrangem ents so active ? Ibelieve it to be because the process of dissolution effected inthe epileptics paroxysm prior to the mania is the most rapidof all processes of dissolution—control is most rapidly removed.

Let me try again to make this clear by formulating it other-wise. W e have not only to consider " depth " of dissolution,but the rapidity with which the dissolution is effected—controlremoved. I believe we may say that the deeper the dissolu-tion, the more general and more automatic are the processesremaining, and that the more rapid the dissolution, the moreexcitable are the nervous arrangements for those processes.So that with shallow and yet rapid dissolution the actions are

elaborate and also bu sy ; with deep and rapid dissolution,they are simple and also violent (it is not a qiiestion of" importance " of actions).

I presume then that the more rapid the destruction of thepart in the left half of the brain, the more excitable would bethe nervous arrangements in the corresponding undamagedright half, and thus that the activity of it would be greater—

greater for some time after the onset of the illness. But themore rapid the destruction, the more quickly there would beloss of consciousness; thus the then external circumstancewould be unable to act at all, and although the lower centrem ight be more excitable than usual, there would be no thingfor it to manifest as a result of what was saying or doing atthe onset of the illness.

To recap itulate. By considering (1) the external circum-stances at the time of the being taken ill; (2) the intensityof the emotional state under which the last attempt at speechwas made ; and (3) the gravity of the lesion, we may perhapsbe able to show why this or that kind of recurring utteranceremains in particular cases of speechlessness.


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W e shall now consider phenomena analogous to recurring

utterances in some cases of defect of speech (No. 1, Vol. I.p. 314), in order to widen the basis of investigation.

The patient who has defect of speech may get out a word,right or wrong, and go on utte ring i t ; or he may even g et

out a proper rep ly, such as " very w ell," and go on utt erin g

th at in rejoinder to further questions to which it is irrelevant,being aware of that irrelevance. To use Gardine r's expres-

sion, who drew attention to this peculiarity, the patien t getsthe word or phrase "o n his barrel-organ." I t becomes a

temporary recurring u tter an ce; the permanent recurring

utterance in loss of speech may be called permanent barrel-organism. In cases of defect of speech the pa tien t may write

a little, and then go on writing the same syllable or word orphrase over and over again. Here again is evidence, althou gh

indirect, of " barrel-organism " of words or syllables.

The following is a letter written by a patient who haddefect of spe ech : it was not punctuated. H e first wrote his

address correctly, which for obvious reasons I do not give, Isubstitute " H urst Row, N orth Newington R oad " for i t ; the

address recurs in the le tte r; the factitious address is pu t inplace of it:—

" Dear Sir. I feel very well just now " (" for now " and " Ifeel " came next, bu t are crossed out) " for Hurst Row I feel

very well just now for th ingg in th e first way for the tham k

now. I know now I was in the first now in th e first now in

the Newington Road I keep you first way in New ingtonRoad the poor way is the best way is the best way for me isthe best way for me is the best way for m e is th e best way

the way is the best for me for ways kept for me for kept wayskept me for way kept for me."

Here ends the letter. There is, however, plainly som ething

more than barrel-organism in it.From what would be generally called the physical sphere

we obtain illustrations in some cases of loss of speech of"barrel-organ ism." If, after g etting an aphasic to protrude

his tongue, we ask him to put his hand on his head, he may,instead; open the mouth and perhaps put out the tongue.

This, I grant, may be of doubtful interpretation.


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Here let us note another peculiarity in cases of defect ofspeech, which, perhaps, can only be shown to concern usind irectly in regard to what has been said. I t is a very

important matter in the elucidation of the nature of defects ofspeech, and may properly be m entioned now in order to sug-gest inquiry if there be anything analogous in the recurringutte rance in cases of loss of speech. In some cases of defectof speech we find that the patient who has uttered a word orphrase correctly, and who goes on re-uttering it as a reply,cannot repeat it when he is told and when he tries. H ehas said correctly, " I don't know." W e tell him to say " I

don't kno w;" he fails. W hether there is anyth ing strictlyanalogous to this in the case of permanent barrel-organ-ism Nos. 1, 2, and 3, as there is of " no," No. 4, willnot be easy to determine. Fo r if we ask the patient tosay his elaborate recurring utterance, ju st as we ask patientswho reply " n o " to say tha t word, there is the difficultythat the recurring utterance comes out when they try to

say anything; and thus its coming out may be not saying

it, bu t simply utter ing it as at any other time. I confessI have no personal observation on this matter worth men-tioning. I t has long been known that some aphasics atleast cannot say parts of their recurring u tterances . Thus apatient of Bazire's uttered " sapon, sapon," bu t could neversay " sap " or " pon " only. Trousseau makes analogous ob-servations. But here obviously there is a difficulty. W hatwe call part of a word is really another word or syllable . Apatient who consulted me for loss of speech learned to my—notmerely to utter— " Battersea " ; but she could not say " batter."When asked to say it, she said " Battersea."

Here we may make further remarks on dual m ental action,taking this time not the process ending in ideation or percep-tion, or both, but the process ending in voluntary, as dis-tinguished from autom atic actions. W hat we now say may

serve to integrate remarks which necessarily came now andthen incidentally in discussing different parts of our maintopic. W e make a few preliminary observations.

W e must bear- in mind that " will," " mem ory," and " emo-tion" are only the names men have invented for different

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aspects of the ever present and yet always changing latestand highest mental states, which in this locality constitute

what we call consciousness—consciousness being really a name

for a series of varying and different consciousnesses. There is,however, a double series; subjective and regular conscious-nesses. Each one of the series of object consciousness

is secondary to a state of consciousness or subconscious-

ness, represen ting us altogether subject-consciousness. I t is

this duplication, I suppose, which gives us the feeling that wehave a sort of general and persisting consciousness^ and are

also now, now, and now, conscious, this or th at particu lar way,

and which makes us say that this or that sensation or imagecomes into consciousness; or tha t we have a sensation and .know that we have it.

Taking "will," "memory," and "emotion" to be real in-

dependent entities or faculties reminds one of the old woman'sremark, " How lucky it was that Adam called all the animals

by their right names."

To say a word or proposition when told, "for the sake ofsaying it ," is not a language process at all. A speechless man'sinability to say " no " when told (see VoL II. p. 213) is a thing

of the same order as his inability to protrude the tonguewhen told. The consideration of such facts will help us to

classify the phenomena of cases of aphasia on a deeper basisthan tha t of language . To use an expression somewhat loose

in this connection, there is loss of certain voluntary actionsin some cases of aphasia, with conservation of the more auto-

matic—a dissolution affecting more than language processes,and affecting language processes not so much as language

processes, but as they are some of the volun tary actions. W ehave to consider speech on this wider basis in order that we

may be better able to see how speech is part of mind, and thusto get rid of the feeling that there is an abrupt and constant

separation into mind and speech.It is in considering the nature of these phenomena that we

see, I think, the bearing of Spencer's remark on the distinc-tion betwixt voluntary and involuntary operations. There we

have to do with dua lity of mental processes. In th e voluntaryoperation there is preconception; the operation is nascently

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PROM DISEASE OP THE BEAIN 349

done before it is actually do ne ; there is a " dr ea m " of anoperation as formerly doing before the operation; there isdua l action. Before I put out my arm volun tarily I must

have a " dream " of the hand as being already put out. So too,before I can think of now putting it out I must have a like" dream," for the difference betwixt thinking of now doing andnow actua lly doing is , like the difference betwixt interna l speechand external speech, only one of degree; in one there is slightdischarge of a certain series of nervous arrangements, in theother strong discharge of tha t series. The " dr ea m " mustoccur before I either th ink of now doing something, or before

I actually do tha t thing , just as words must be reproduced inme before either I can say them to myself or aloud. To saythat we know what we -are going to do, or that we are intend-ing to do this or that amounts to adm itting the above hypo-thesis. These expressions imply our having a nascent excitationof nervous arrangements representing the parts formerly con-cerned in doing that which is now to be done again. If we saywe are tryin g to do something, we mean similarly, and so wedo if we say we remember how to do anything; there beingno " faculty " of remembering an action apart from having theaction (as it was formerly doing), again actual, althoughfaintly actual, nascen t To "w ill," to "know ," to "inte nd ,"to " try ," to " remember," have each, in their several contextsabove, the same meaning. They are different names for thesubjective reproduction which precedes objective reproduction;

they are names for " dreams " of what was once doing, and isnow to be attempted again. Indeed the simple expressions," He speaks," " H e does so and so," imply the du al ity ; implyobjective activ ity following subjective activity . " He speaks,"or " H e does," implies a then temporary duplication of aperson into subjective and objective; " h e " represents thatperson's whole self of course, and " speaks " or " does," repre-sents something doing by his whole self. " H e " represents

the whole of him in the Btage we have figuratively calledhav ing a " dream " of a past operation, " speaks " or " does "represents the whole of him in the stage of imitating it. (W esay figuratively, because we do not mean a visual dream, buthaving again sensations representing parts of the body dis-


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placed, and as being m oved thu s or thus.) To take a simplercase, in speaking of which, however, usage will not allow appli-

cation of the terms " voluntary " and " involuntary ." " H e

has this sensation." Subjectively, there is a sensation arisenin him which associated directly with others, and by them

indirectly with all others—all that have been organised.Objectively there is disassociation, the sensation is consideredseparately from all others that are organised and in relation to

those now organising. W e may fancifully pu t the duplicationt h u s : " He has it," and " He has it ;" thus artificially sepa-rating what is a rhythm of a subjective and objective state.

W hen then we assert that a speechless man tries to say " no "and fails, we are tacitly affirming that he has the word " no "revived in himself, a " dream " of the word. He has the sub-

jective word " no," but not the objective word " no ," therebeing really two "noes," all words being in the duplicateof subjective and objective. So, were we to use popular

language, and to say of a patient who " tries " to pu t out his

tongue, and fails, or who tries to say " no," and fails, that hehas lost part of his volition, we should only mean that he had

lost not a part of some faculty, but the very objective actionsthemselves, their nervous arrangements being broken up; hehas lost a part of himself. And were we to say that the

patient desires to do those things, we should only mean thathe retains the subjective actions, which in health are precedent,and are to him the preconception of the objective actions

which cannot follow, for the simple reason that they do notexist. I suppose such expressions of duplica tion of mentalstates, " ideas of actions," " memory of words," " feeling, a

sensation," and " knowing that we have this or that feeling," &c,imply that there is first and subconsciously the action, or theword, or the particular sensation associated with (because arisen

out of), the already organised in our whole selves (subjectiveactions, words, &c), before the second reproduction of them orrather of their duplicates in relation to what is then organising

from the environm ent. A subjective word is first a cen tre ofassociation with all other organised words, symbolising all

other images, and afterwards a symbol of a particular image;an objective word is first a symbol of a thing, and next acquires


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FBOM DISEASE OP THE BRAIN. 351

new associations with other words, then using along with it

and similarly arisen to indicate new relations of things in the

environment.

In healthy speech it is hard to see how we can have aproposition (either in the degree of internal or in that of

exte rna l speech) before the words of th at proposition have been

subjectively revived. Otherwise how should we be more tha n

machines ? Words must have arisen in us in an order sym-

bolising states arisen in us, before a proposition we utte r can

have for us' any meaning as symbolising external relations of

things one to another in the environment. To use popular

language, we must first remember the words and then saythem.

W e do not, as already incidentally implied, mean that theparts of the subjective and of the objective process are arranged

in the same order.

Let us return to the simple movement of the arm . The

" dream" here begins of course with that which corresponds

to what is the end of some operation which was actually doneon some former occasion. If I am to put out my arm so far I

must have a " dream," beginning with the hand being so far

pu t o ut ; and nex t of it as in varying positions up to tha t state

of rest from which the movement really began when it was

formerly done. If th is were not so, we should not know what

we were going to d o ; the end must come first subjectively,

before the objective process can in any voluntary action begin,

and can go on to that end. Th is implies that two differentnervous unite Are engaged. One of the twins represents (a)

incoming currents from skin stretched, muscles moving or

balanced by antagonism from joints, &c, in the limb engaged,

and (b ) curren ts coming from the rest of the body, as being

thu s or thu s fixed, or as thu s or thu s variously displaced during

th e particular local movem ent of the limb. And of course

there is an accompanying series of outgoing currents, for if

there were no motor element we should have no knowledge ofthe relations of the parts moved to one another and to the

rest of the body; incoming currents would not suffice to give

this relation any more than incoming currents from retiredelements, without accompanying ocular movement, would



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suffice to give us a knowledge of the relations of theseelements one to another; and, plainly, unless retired elements

are first known as out of one another, impression on them by

objects would give us no notion of the exterior of thoseobjects. Similarly, un til we have already a knowledge of the

relation of parts of the body one to another, we could not

begin to make any movement of part of the body to operate on

the environment. During discharge of this unit a psychical

state of what was formerly doing arises- W hen the operation

is to be repeated, to be done now voluntarily, the other unit

discharges the operation, starting from an attitude of the bodyand passing on to the end of the operation by the limb.

Manifestly this m ust begin by an a ttitude of the body, and

the progress in the arm will be from the shoulder to the hand,

in an opposite order to the " dream -mo vem ent" I t is during

the play of these two movements that what is called muscular

sense arises. The psychical side of one process is pa rt of what

we call desire, of the other, of what we call effort.

That subjective states arise in an order the opposite ofthat they are arranged in in corresponding objective Btates is

supported by the analogy of some dreams. A noise develops

a dream , but, sometimes a t least, the noise, which in reality

acts on the sleeper first, is last in the dream it excites. In all

dreams provoked by local excitations I suppose the transfigured

excitation comes either last or later than the excitation itself.

And I suppose that in such a proposition as " gold is yellow,"

the subjective order.is the reverse of the sequent objective

order; for our concern is first with the yellowness of gold, not

with gold. This view is, I th ink, in harmony with what was

said on transposition of syllables in mistakes of the slightly

aphasic and the healthy. I believe there to be dua lity also

in automatic operations; but in this case the movement has

so often followed the dream that the two are nearly equally

perfect and easy. The voluntary operation, the prior " dream ,"is imperfect, or, if perfect, the movement done after it doesnot imitate it clo sely; we try to do so, and fail. Becom ing

automatic by repetition is, on the physical side, for the two

units to discharge more nearly together, because lines of

less resistance are established; there is less delay betwixt

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FBOM DISEASE OF THE BEAtN. 353

them, and thus preconception through the discharge of thefirst unit and less sense of effort during discharge of thesecond. Thus less and less consciousness attends processes

the more they become automatic; subjective and objectiveactions become, as it were, nearly fused.

Let us now take other kinds of nervous affection whichshow something analogous to permanent barrel-organism ofspeechless patien ts. W e wish to point out th a t there isevidence that operations going on at the time of unconscious-ness supervening remain nascent or in abeyance—are n otalways swept away— during the unconsciousness. During the

restoration to consciousness they become active again; onfull restoration to consciousness, they cease.

Direc tly after or in coma from various causes, we occasion-ally see a reversion to actions doing when the comatisinglesion occurred. An ostler coming round from coma, due tothe k ick of a horse he was grooming, began to " hiss," asgrooms do when engaged in nibbing down horses (Brodie).1

Abercrombie writes : A lady, whose case has been communi-cated to me, was seized with an apoplectio attack whileengaged at cards. The seizure took place on a Thursdayevening, she lay in a state of stupor on Friday and Saturday,and recovered her consciousness rather suddenly on Sunday.The first words she then uttered were by asking , " W ha t ist r u m p s ? "

I suppose the above instances show that actions nascen t at

the time when the illness occurred remained so during thecoma, and went on again actively when consciousness wasbeing restored; on full restoration to consciousness theyceased ; the barrel-organism was temporary, because th ehighest nervous centres were only temporarily hors de combat.

The following case, kindly supplied to me by Dr. Buzzard,

1I suppose the following to be analogous, although consciousness was only

partly restored: the action of laying the oiloloth had become ''harrel-organic."A woman I was asked to see i n a surgical ward of the Lon don Hosp ital, who

fractured her skull by a fall when laying down the oilcloth on a staircase, kopt,

during partial unconsciousness a few hours before death, manipulating the

counterpane of her bod. W e supposed this to be a continuan ce of the action of

layin g the oilcloth; the pationt desisted for a time, at least whe n the nurse

assured her " it was properly la id."


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354 ON AFFECTIONS OJf SPEECH

has never been published. I t may be taken as a faithful

record, since the observer's qualifications as a neuropathologistare of the very highe st I t is one of extreme value in many

ways."About fifteen years ago, a medical friend of mine, some

57 years of age, was pitched on to his head, owing to the horsewhich he was riding having pu t his foot in a drain. He wastaken home in a state of profound insensibility, in which I

found him very shortly afterwards. From the symptoms itwas probable th at he had fractured the base of his sku ll. Fo rBome hours (I have no note of the num ber) he lay in a state

of deep coma, incapable of being aroused. Fro m th is his con-dition gradually changed to a state in which he appeared tosleep, bu t would reply ' Y es' or ' N o ' to questions put to

him. H e did not appear to notice any thing about him, andnever volunteered a remark, but scarcely ever failed to replyin the way described, and with such an amount of propriety

that I remember it was difficult at first to believe that he

was unconscious. Offered food, he would sit up in bed, dr inkit without a word, lie down again and go to sleep. On oneoccasion I wanted him to take a common black draught, buthe appeared to resent this , said ' No I no I' fiercely, and

turned away. By a litt le persistence, however, he was inducedto swallow i t H e would get out of bed, take the chamberutensil out of its place of concealment, and pass urine regard-

less of any one in the room.

" One morning, to my astonishment, he got up, walked to hisshaving-glass at the window, and proceeded to lather his chin.He then shaved himself, with very fair completeness, andreturned to bed. I happen to know that this was the way in

which he invariab ly commenced h is morning toile tte, for hewas a late riser, and he had frequently risen and shaved him-self during my vi sit From this day he got up every morn-

ing about the same time, repeated the operation of shaving,and then returned to bed. The action was performed withthe same evident unconsciousness of the presence of others

which we see in the somnambulist. Having returned to bedhe would lie for the rest of the day in a dozing state, whichwas only interrupted by his taking food and passing his


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PROM DISEASE OP THE BRAIN. 355

evacuations, which actions were evidently performed in apurely automatic mannei

" U pwards of a fortnight from the time of his accident he

woke up into consciousness, noticed persons in the room, andmade some slight remark. Little by little during the nexthour or two he began to converse at greater length, referredto circumstances relating to his business which had occurred

before his injury, and it became presently evident that thetime during which he had been in bed had left no trace uponhis memory. Of the injury itself he knew no thing whatever,

the last thing which he remembered being that he was riding

on horseback." W hen asked the day of the week and month he unhesi-

tatingly gave the date upon which (more than a fortnightpreviously) he had met with the injury, and became quiteangry when assured th at he was mistaken . The period of his

illness had been cut out, as it were, of his life in the cleanestand most complete manner, and not a trace of it has ever

since presented itself to his mind."In the above-mentioned cases the pa tien ts recovered, andthus their cases are not closely analogous to our cases of per-manent barrel-organ utterances in aphasia. A patient who

recovers soon from aphasia loses his re currin g utte rance,becomes able not to ut ter it. These cases are analogous, andso is the temporary barrel-organism of some patients with

defect of speech. In the perm anent barrel-organism, or recur-

ring utterances of patients who remain speechless, the restora-tion of the pa rt (in the left half of the brain) placed hora de

combat is impossible; it was destroyed altogether. The fol-lowing case is more closely analogous to these cases than theabove. Abercrombie relates (after Oonolly) : " A young clergy-

man, when on- the po int of being married, suffered an injuryof the head by which his understanding was entirely and

permanently deranged. H e lived in this condition till theage of eighty, and to the last talked of nothing but hisapproaching wedding, and expressed impatience of the arrival

of the happy day."What does recovery in the case of the cures of barrel-

organ actions mentioned m ean? I t means restoration to


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356 ON AFFECTIONS OF SPEECH, ETC.

functions of some or enough of the highest nervous arrange-

ments ; it means re turn of control. But in cases of speech-lessness from entire destruction of nervous elements there

can be no restoration ; the control does not return . Therecurring utterance remains, and by repetition becomeshighly organised.


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1879 Jackson on Affection of Speech From Disease of the Brain 3

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Transcript of 1879 Jackson on Affection of Speech From Disease of the Brain 3