cases of extensive injury about the fronto-temporal regions, as a complication of aphasic disease. Nothnagel suggests that whilst the cuneus is the seat of optical sensations, the other parts of the occipital lobe may be the field of optical memories and ideas, from the loss of which mental blindness should ensue. In fact, all the medical authors speak of mental blindness as if it must consist in the loss of visual images from the memory. It seems to me, however, that this is a psychological misapprehension. A man whose power of visual imagination has decayed (no unusual phenomenon in its lighter grades) is not mentally blind in the least, for he recognizes perfectly all that he sees. On the other hand, he may be mentally blind, with his optical imagination well preserved; as in the interesting case published by Wilbrand in 1887.* In the still more interesting case of mental blindness recently published by Lissauer,† though the patient made the most ludicrous mistakes, calling for instance a clothes-brush a pair of spectacles, an umbrella a plant with flowers, an apple a portrait of a lady, etc. etc., he seemed, according to the reporter, to have his mental images fairly well preserved. It is in fact the momentary loss of our non-optical images which makes us mentally blind, just as it is that of our non-auditory images which makes us mentally deaf. I am mentally deaf if, hearing a bell, I can't recall how it looks; and mentally blind if, seeing it, I can't recall its sound or its name. As a matter of fact, I should have to be not merely mentally blind, but stone-blind, if all my visual images were lost. For although I am blind to the right half of the field of view if my left occipital region is injured, and to the left half if my right region is injured, such hemianopsia does not deprive me of visual images, experience seeming to show that the unaffected hemisphere is always sufficient for production of these. To abolish them entirely I should have to be deprived of both occipital lobes, and that would deprive me not only of my inward images of sight, but of my * Die Seelenblindheit, etc., p. 51 ff. The mental blindness was in this woman's case moderate in degree. Archiv f. Psychiatrie, vol. 21, p. 222. sight altogether.* Recent pathological annals seem to offer a few such cases.† Meanwhile there are a number of cases of mental blindness, especially for written language, coupled with hemianopsia, usually of the rightward field of view. These are all explicable by the breaking down, through disease, of the connecting tracts between the occipital lobes and other parts of the brain, especially those which go to the centres for speech in the frontal and temporal regions of the left hemisphere. They are to be classed among disturbances of conduction or of association; and nowhere can I find any fact which should force us to believe that optical images need be lost in mental blindness, or that the cerebral centres for such images are locally distinct from those for direct sensations from the eyes. § Where an object fails to be recognized by sight, it often happens that the patient will recognize and name it as soon as he touches it with his hand. This shows in an interest *Nothnagel (loc. cit. p. 22) says: Dies trifft aber nicht zu. He gives, however, no case in support of his opinion that double-sided cortical lesion may make one stone-blind and yet not destroy one's visual images; so that I do not know whether it is an observation of fact or an a priori assumption. + In a case published by C. S. Freund: Archiv f. Psychiatrie, vol. xx, the occipital lobes were injured, but their cortex was not destroyed, on both sides. There was still vision. Cf. pp. 291-5. I say 'need,' for I do not of course deny the possible coexistence of the two symptoms. Many a brain-lesion might block optical associations and at the same time impair optical imagination, without entirely stopping vision. Such a case seems to have been the remarkable one from Charcot which I shall give rather fully in the chapter on Imagination. Freund (in the article cited above 'Ueber optische Aphasie und Seelen blindheit ') and Bruns ('Ein Fall von Alexie,' etc., in the Neurologisches Centralblatt for 1888, pp. 581, 509) explain their cases by brokendown conduction. Wilbrand, whose painstaking monograph on mental blindness was referred to a moment ago, gives none but a priori reasons for his belief that the optical 'Erinnerungsfeld' must be locally distinct from the Wahrnehmungsfeld (cf. pp. 84, 93). The a priori reasons are really the other way. Mauthner (Gehirn u. Auge' (1881), p. 487 ff.) tries to show that the 'mental blindness' of Munk's dogs and apes after occipital mutilation was not such, but real dimness of sight. The best case of mental blindness yet reported is that by Lissauer, as above. The reader will also Ballet: Le Langage do well to read Bernard : De l'Aphasie (1885) chap. v: Intérieur (1886), chap. vIII; and Jas. Ross's little book on Aphasia (1887), ing way how numerous the associative paths are which all end by running out of the brain through the channel of speech. The hand-path is open, though the eye-path be closed. When mental blindness is most complete, neither sight, touch, nor sound avails to steer the patient, and a sort of dementia which has been called asymbolia or apraxia is the result. The commonest articles are not understood. The patient will put his breeches on one shoulder and his hat upon the other, will bite into the soap and lay his shoes on the table, or take his food into his hand and throw it down again, not knowing what to do with it, etc. Such disorder can only come from extensive brain-injury.* The method of degeneration corroborates the other evidence localizing the tracts of vision. In young animals one gets secondary degeneration of the occipital regions from destroying an eyeball, and, vice versa, degeneration of the optic nerves from destroying the occipital regions. The corpora geniculata, thalami, and subcortical fibres leading to the occipital lobes are also found atrophied in these The phenomena are not uniform, but are indisputable; so that, taking all lines of evidence together, the special connection of vision with the occipital lobes is perfectly made out. It should be added that the occipital lobes have frequently been found shrunken in cases of inveterate blindness in man. cases. Hearing. Hearing is hardly as definitely localized as sight. In the dog, Luciani's diagram will show the regions which directly or indirectly affect it for the worse when injured. As with sight, one-sided lesions produce symptoms on both sides. The mixture of black dots and gray dots in the diagram is meant to represent this mixture of 'crossed' and 'uncrossed' connections, though of course no topographical exactitude is aimed at. Of all the region, the temporal lobe is the most important part; yet permanent absolute deafness did not *For a case see Wernicke's Lehrb. d. Gehirnkrankheiten, vol. II. p. 554 (1881). + The latest account of them is the paper Über die optischen Centren u. Bahnen' by von Monakow in the Archiv für Psychiatrie, vol. xx. p. 714. result in a dog of Luciani's, even from bilateral destruction of both temporal lobes in their entirety. * In the monkey, Ferrier and Yeo once found permanent deafness to follow destruction of the upper temporal convolution (the one just below the fissure of Sylvius in Fig. FIG. 16.-Luciani's Hearing Region. 6) on both sides. Brown and Schaefer found, on the contrary, that in several monkeys this operation failed to noticeably affect the hearing. In one animal, indeed, both entire temporal lobes were destroyed. After a week or two of depression of the mental faculties this beast recovered and became one of the brightest monkeys possible, domineering over all his, mates, and admitted by all who saw him to have all his senses, including hearing, 'perfectly acute.' † Terrible recriminations have, as usual, ensued between the investigators, Ferrier denying that Brown and Schaefer's ablations were complete, ‡ Schaefer that Ferrier's monkey was really deaf.§ In this unsatisfactory condition the subject must be left, although there seems no reason to doubt that Brown and Schaefer's observation is the more important of the two. In man the temporal lobe is unquestionably the seat of the hearing function, and the superior convolution adjacent to the sylvian fissure is its most important part. The phenomena of aphasia show this. We studied motor aphasia a few pages back; we must now consider sensory aphasia. * Die Functions-Localization, etc., Dog X; see also p. 161. Brain, vol. xI. p. 10. § Ibid. p. 147. Our knowledge of this disease has had three stages: we may talk of the period of Broca, the period of Wernicke, and the period of Charcot. What Broca's discovery was we have seen. Wernicke was the first to discriminate those cases in which the patient can not even understand speech from those in which he can understand, only not talk; and to ascribe the former condition to lesion of the temporal lobe.* The condition in question is word-deafness, and the disease is auditory aphasia. The latest statistical survey of the subject is that by Dr. Allen Starr. + In the seven cases of pure word-deafness which he has collected, cases in which the patient could read, talk, and write, but not understand what was said to him, the lesion was limited to the first and second temporal convolutions in their posterior two thirds. The lesion (in right-handed, i.e. left-brained, persons) is always on the left side, like the lesion in motor aphasia. Crude hearing would not be abolished, even were the left centre for it utterly destroyed; the right centre would still provide for that. But the linguistic use of hearing appears bound up with the integrity of the left centre more or less exclusively. Here it must be that words heard enter into association with the things which they represent, on the one hand, and with the movements necessary for pronouncing them, on the other. In a large majority of Dr. Starr's fifty cases, the power either to name objects or to talk coherently was impaired. This shows that in most of us (as Wernicke said) speech must go on from auditory cues; that is, it must be that our ideas do not innervate our motor centres directly, but only after first arousing the mental sound of the words. This is the immediate stimulus to articulation; and where the possibility of this is abolished by the destruction of its usual channel in the left temporal lobe, the articulation must suffer. In the few cases in which the channel is abolished with no bad effect on speech we must suppose an idiosyncrasy. The patient must innervate his speech-organs either from the corresponding portion of the other hemisphere or directly from the centres of ideation, * Der aphasische Symptomencomplex (1874). See in Fig. 11 the convolution marked WERNICKE. t 'The Pathology of Sensory Aphasia,' 'Brain,' July, 1889. |