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what has been termed the pariah of nature.' Not the magic wand of Prospero or the brave kiss of the daughter of Hippocrates ever effected such a change as that which we are now enabled to make in these unfortunate victims, doomed heretofore to live in helpless imbecility, an unspeakable affliction to their parents and relations."

The thyroid treatment in the following case brought about a marvellous change:

H., female, aged 5 years and 7 months. Family history negative. Past history: Disease began to develop after first year; nursed until two and a half years old; was fed milk and eggs afterward. Cut first tooth when twelve months old; was two years old before she cut lateral incisors. (See Fig. 1.) Bowels obstinately constipated. Could talk but little. Was nearly four years old before she could stand alone. She would sit for hours in one position. She would occasionally have crying spells which would last for an hour or two. Wants to be by herself, and does not care to play with other children. Bowels do not move unless a purgative is given; actions are always large and bad smelling. Mother says that during the hottest weather the child does not sweat.

Present condition, April 25, 1898: Photograph taken April 25 gives a good picture of her at this time. (See Fig. 2.) She walks about as well as an eighteen months old child. Her gait is tottering and uncertain; frequently falls while walking over the floor. Abdomen large and prominent. Anterior fontanelle about size of silver half dollar. Posterior fontanelle slow in closing. No enlarged inguinal glands. Liver and spleen slightly enlarged. Spinal curvature characterized as shown in photograph. Has bronchitis and laryngo-spasm. Skin harsh, dry, scaly, and has thick, muddy look. Pathognomonic facies. Head small, nose broad and opening turned up; bridge flat. Lips large, tongue thick and filling mouth. Hair on head coarse and thick; fine, dark hair on back, between the shoulder blades. Bones of arms and legs normal. Fingers short and clubbed. Voice hoarse and disagreeable. Skin dry and free from perspiration. Feet small and infantile; wears No. 4 child's shoe. Talks but little. At times very irritable. No thyroid gland could be made out. Height 33 inches; according to Boston measure should be at this age nearly 43 inches. Circumference of head 19 inches; of abdomen, 21 inches; of chest, 20 inches.

Ordered one-third of one of Parke, Davis & Co.'s five-grain thyroid tablets three times a day, this dose representing 1-45 of a sheep's thyroid.

May 23. Has been taking one five-grain thyroid tablet a day since April 25th. Thyroid makes her restless and nervous; complains of headache. After taking a dose of thyroid the heart beats strong and fast. She sweats freely. Hair has lost its dry, coarse look. Skin is moist and smooth. Bowels move two or three times a day. Abdomen has lost much of its prominent appearance. Tongue and lips not nearly as large. Has grown one-half inch in twenty-eight days.

June 6. Still taking one five-grain tablet a day. Increasing the dose causes headache, rapid heart action and marked nervousness. Feet seem to grow faster than any other part. Sweats freely. Anterior fontanelle much smaller. Circumference of abdomen 20 inches-a loss of 11 inches. Bowels act freely. Talks, and is lively. Facial expression much more intelligent. Lips and tongue very near normal. Voice not so harsh, and is at times pleasant. Plays with other children. Runs about and takes great interest in what is going on about the house. The change in the child is remarkable. Height 34 inches. Ordered one and a half tablet a day.

October 8. Has had some spells of sickness since last observed, and medicine has not been given regularly. Has grown 3 inches since April 25th. Runs about with ease. Climbs fences and trees with other children. Anterior fontanelle very nearly closed. Has almost entirely lost the myxedematous appearance. Mental condition improving rapidly.

January 26, 1899. Two five-grain tablets a day make her exceedingly nervous and restless. On account of sickness medicine has not been given regularly. Still improving. A faith healer to whom the child had been taken before coming under my care claims credit for the improvement of the child. April 25. Since last of February she has been taking three five-grain tablets a day. Anterior fontanelle closed. Has grown 53 inches in one year. (See Fig. 3.) Her brother, two years younger, has grown in the same length of time 2 inches. Beginning of thyroid treatment she wore No. 4 shoe, now wears 8. While she has not entirely lost the cretinoid appearance, she is improving so rapidly that it is hard to find evidence of myxedema. She is a great talker and is very inquisitive. Is learning to make letters and figures, and uses pencil well.

Osler mentions the following gains in height of cretins fed on thyroid:

One case gained 11 inches in one year and ten months. Another gained 9 inches in one year and seven months. Another gained 8 inches in four and a half months. Another gained 7 inches in six months.

Hollowell Building.

A CASE OF APHASIA DUE TO TRAUMATISM. THE MEDULLA AS A SPEECH CENTER.*

BY W. F. ROCHELLE, M.D.
JACKSON, TENN.

It is interesting to study the evolution of our present knowledge of the condition of impaired speech known as aphasia— a condition of disease or of injury to the special areas of the brain that are concerned in the idea or production of articulate language.

A condition of aphonia from injury to or disease of the vocal organs, the various manifestations of dumbness from hysteria, mental aberrations, etc., are not to be confounded with the present study of aphasia. Thucydides, Pliny, and many of the older writers alluded to this condition in a general way, and down to a few years ago the most that was known of it was embodied in the general term, loss of memory, and we can only make the distinction between the condition of aphasia and aphonia by noting the symptoms as given by these ancient writers.

Skipping much that is written down to 1798, we find Dr. Crishton reporting many interesting cases of what he classes under the general term, defects of memory. One case of special interest was a man who at the age of 70 still worshiped freely at the shrine of Venus, and, as the author concludes, for which offense against the frailties of age, he was suddenly seized with great prostration of strength, giddiness, forgetfulness, insensibility to all the concerns of life, and every symptom of approaching fatuity. Instead of asking for bread. he would probably ask for his boots; but if these were brought he knew they did not correspond with the idea he had of the thing he wished to have, and was therefore angry, yet would still demand some of his boots and shoes, meaning bread. If he wanted a tumbler to drink out of, it was a thousand to one he did not call for a certain chamber utensil, and if it was the said utensil he wanted, he would call it a tumbler or dish. It was left to Dr. Gall, a German physician, in the early part of the nineteenth century, to make the first attempt to * Read before Tennessee State Medical Society, Nashville, April 11, 1899.

define the seat of the faculty of language, and to establish its existence. But Gall's ideas were vague and uncertain ; he knew there were centers of speech in the brain, but where they were located, how many, etc., was not plain to him. The subject was studied by such Frenchmen as Bouillaud, Cruveilheir and others, during the first half of the century. Many cases are reported from these labors and portray vividly the gradual growth of the knowledge of the speech center.

The opinions and observations of these men were so vague and varied that at different stages of their investigation it was thought that most any part of the brain might control the speech center, one side, both sides, either side or neither side. But early in the last half of the century we find a new era beginning in our own country in this same study of the speech center. Dr. Harlow, of Vermont, reported his case of the man who was the victim of the crowbar passing through his head, with only a few minutes' loss of consciousness and no impairment of speech, except a marked augmentation of the faculty of profanity. In 1861 the skull of this man wast examined and written up, and showed that much of the heretofore speech center had been destroyed. Dr. Jackson reported another similar case of a man blasting rock who had a piece of gaspipe pass through the front of the skull. The patient recovered in a few months and regained partially his lost memory.

These cases had a tendency to disprove the former theory of the French teachers, and were the groundwork for a more careful and persistent study of these brain centers, which resulted in the drift of opinion turning to the theory of Dr. M. Dax, who contended as early as 1835 that Gall and Bouillaud were wrong in their deductions, and claimed that the faculty of language was seated in the left anterior lobe of the brain. Broca was an avowed opponent to the theory of Bouillaud until his bout with his friend Auburtin, who contended. that a patient then under the care of Broca was suffering from disease of the anterior lobe, whereupon Broca accepted his challenge and promised a post-mortem examination, which was made afterward. This examination not only showed disease of the anterior portion of the brain as contended by

Auburtin, but was limited to the left anterior lobe. Which fact not only convinced Broca of the theory, but was a basis for further study on the subject, which resulted in the christening of this the Broca center. The study of the speech center now made rather rapid strides (comparatively so), and aphasia was divided into amnesic or sensory, and ataxic or motor, and defined separately from aphonia or loss of voice from local causes, etc.

According to the observations of Broca, Wernicke, Kussmaul and others, it is now known that the speech center is located in the left anterior lobe, with fibers radiating down through crus and pons to the medulla, with associating tracts running to the left temporal lobe to the seat of hearing, and through the occiput to the center of sight.

That the motor areas are located in the entire speech tract, that the memory areas occupy the Broca center, the center of hearing and the sight center, is at present about settled.

When a lesion is located in the Broca or third frontal convolution, we find that the symptoms are loss or impairment of correct articulation, and a marked embarrassment due to the consciousness of this defect, in many cases causing the patient to become mute rather than expose himself to criticism or ridicule.

When the lesion is located in the first temporal convolution we expect to find a condition of word deafness. In this condition the patient is unable to comprehend spoken language, because the center of hearing has been impaired. He is not deaf to sound, but he fails to appreciate the meaning of certain sounds. His own tongue is as unintelligible to him as a foreign language. Efforts to talk or to read aloud result in an unintelligible jargon, which the patient does not recognize as in any respect unnatural or inexpressive of ideas he desires to communicate to you, because his ear does not properly interpret his own utterances.

When a lesion of the visual center or the occipital lobe is involved, we find a condition of word blindness. This is loss of memory for printed or written symbols of words. Such patients can remember and recognize familiar places, objects, faces, etc., but they cannot read correctly. They may be able