On convulsive seizures / by J. Hughlings Jackson.

  • John Hughlings Jackson
Date:
[1890]
Catalogue details

Licence: Public Domain Mark

Credit: On convulsive seizures / by J. Hughlings Jackson. Source: Wellcome Collection.

Provider: This material has been provided by King’s College London. The original may be consulted at King’s College London.

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    clearly articulated. In most of these the prior convulsion starts in the right hand, and, I have thought, most often, not in the thumb or index finger, but in the hand generally or in the ulnar fingers. Of course there are many degrees of'abnormal affection of speech of this kind, and it varies according to the time elapsed since the cessation of the fit. I have not observed post-epileptiform loss of speech, but only defect of speech (“ partial aphasia”). I shall use the term Defect of Speech E, or Partial Aphasia E. The term “ defect of speech” is equivocal, as is also the term “ partial aphasia;” it really covers two opposite elements, negatively loss of some speech, and positively re- tention of the rest of speech.66 The patient gets words out clearly, and may even get out simple appropriate replies, such as “Very well,” and may answer correctly by “Yes” or “No,” or both. This is the positive element: it is the inferior speech to which the patient is reduced. But he is not able to reply correctly except by “ Yes ” and “ No,” and by other simple and very general ex- pressions; he is not able to converse properly on simple subjects; he is unable to explain anything at all complex. These statements give the negative element: the speech lost. It is of extreme importance to distinguish the two opposite elements of the symptomatic condition. It is plainly impossible that the post-epileptiform exhaustion (vide supra), which I suppose there is of part of Broca’s region, can answer to the patient’s utterances—to the positive element: that negative functional state of nervous elements of the region answers to the patient’s loss of some speech. His utterances, positive element, however inferior as speech, answer to activities of nervous arrangement of Broca’s region which are healthy—which are in all ways normal except possibly for slight “ loss of control.” Here is another illustration of the statement that part of the symptom- atology of nervous maladies is the outcome of activity of healthy nervous arrangements.67 We must bear well in mind that speech is a psychical process. Nowhere is it more important to distinguish the psychical from the physical. I say once more that psychical symptoms are to medical men only signs of what is wrong in a material system. Our task as physicians is to ascertain the nature of the physical pro- cess correlative with speech, or more exactly the nature of the 66 My present concern with aphasia is only a very limited one. I need not always supply the obvious qualifications to statements made in the text. The expressions “ loss of some speech” and “ retention of the rest of speech” must not be taken literally as if they meant that the patient had lost certain words or propositions of the (his) English language altogether, and had retained the rest of them intact. Such is an impossible condition of things when an aphasic patient corrects his mistakes. But the statements may be taken literally for the mere purpose of a limited illustration. I do not suppose that there are fixed nervous arrangements— some for these words or syllables (properly movements corresponding to syllables) only and some for those only. I would rather than hold this mechanical doctrine go to the other extreme, and say that there are no nervous arrangements for movements in any centres except at the time when these and those motor nervous elements are functioning together in a particular temporary grouping. 67 It is one thing to locate the negative lesion which destroys speech (renders a person unable to speak aloud), and quite another thing to say that “ speech resides” in any particular part of the cortex. Words, or some other symbols, serve us during thought; when a man is thinking “ gold is yellow,” words in propositions are as certainly concerned as they are when he says that aloud. I submit that the highest centres (“organ of mind”) must be engaged during speech, whether external or internal, notwithstanding that a negative lesion of a part of the middle motor level produces aphasia. Not believing in abrupt localisations, I do not mean by using the term “Broca’s region” to limit the negative lesion productive of aphasia to that part of the lowest frontal convo- lution which enters into the “ motor region.” As is the custom, I shall neglect concern which the highest centres must have with speech.