The eyes become congested and prominent. The cervical glands enlarge. The disease ends in coma and death. Recovery rarely occurs. Sometimes the disease is more violent, and toward the end there are epileptic convulsions and muscular tremors. Autopsies have revealed no pathologic changes.
Recently Forbes contributes an interesting paper on the sleeping sickness of Africa. The disease may occur in either sex and at any age, though it is most frequent from the twelfth to the twentieth years, and in the male sex. It begins with enlargement of the cervical glands, and drowsiness and sleep at unusual hours. At first the patient may be aroused, but later sinks into a heavy stupor or coma. Death occurs in from three to twelve months, and is due to starvation. Forbes reports 11 fatal cases, and two that passed from observation. At the autopsy are found hyperemia of the arachnoid, and slight chronic leptomeningitis and pachymeningitis. There is also anemia of the brain-substance.
In one of his cases the spleen was enlarged. He was inclined to regard the disease as a neurosis.
Aphasia is a disease of the faculty of language, that is, a disturbance of the processes by which we see, hear, and at the same time appreciate the meaning of symbols. It includes also the faculty of expressing our ideas to others by means of the voice, gesture, writing, etc. The trouble may be central or in the conducting media. The varieties of aphasia are:--(1) Amnesia of speech.
(2) Amnesia of speech and written language.
(3) Amnesia of speech, written language, and gesture.
In most cases there is no paralysis of the tongue or speech-forming organs. As a rule the intellect is unaffected, the patient has the ideas, but lacks the power to give them proper expression through words, written language, or gesture. If the patient is enable to write, the condition is known as agraphia.
Word-blindness, word-deafness, etc., are terms of different forms of aphasia.
What was probably a case of incomplete aphasia is mentioned by Pliny, that of Messala Corvinus who was unable to tell his own name; and many instances of persons forgetting their names are really nothing but cases of temporary or incomplete aphasia. In some cases of incomplete and in nearly all cases of complete aphasia, involuntary sentences are ejaculated. According to Seguin a reverend old gentleman affected with amnesia of words was forced to utter after the sentence, "Our Father who art in heaven," the words "let Him stay there." A lady seen by Trousseau would rise on the coming of a visitor to receive him with a pleased and amiable expression of countenance, and show him to a chair, at the same time addressing to him the words, "cochon, animal, fichue bete," French words hardly allowable in drawing-room usage. She was totally aphasic but not paralyzed.
Women often use semi-religious expressions like "Oh dear," or "Oh Lord." Men of the lower classes retain their favorite oaths remarkably. Sometimes the phrases ejaculated are meaningless, as in Broca's celebrated case.
Aphasia may he the result of sudden strong emotions, in such cases being usually temporary; it may be traumatic; it may be the result of either primary or secondary malnutrition or degeneration.
There are some cases on record in which the sudden loss and the sudden return of the voice are quite marvelous.
Habershon reports the case of a woman who on seeing one of her children scalded fell unconscious and motionless, and remained without food for three days. It was then found that she suffered from complete aphasia. Five weeks after the incident she could articulate only in a very limited vocabulary.
In the Philosophical Transactions Archdeacon Squire tells of the case of Henry Axford, who lost the power of articulation for four years; after a horrible dream following a debauch he immediately regained his voice, and thereafter he was able to articulate without difficulty.
Ball records a curious case of what he calls hysteric aphonia.
The patient was a young lady who for several months could neither sing nor speak, but on hearing her sister sing a favorite song, she began to sing herself; but, although she could sing, speech did not return for several weeks. Ball remarks that during sleep such patients may cry out loudly in the natural voice.
Wadham reports the case of a boy of eighteen who was admitted to his ward suffering with hemiplegia of the left side. Aphasia developed several days after admission and continued complete for three months. The boy gradually but imperfectly recovered his speech. Over six months after the original admission he was readmitted with necrosis of the jaw, for which he underwent operation, and was discharged a month later. From this time on he became progressively emaciated until his death, twelve months after Wadham first saw him. A postmortem examination showed nearly total destruction of the Island of Reil, popularly called the speech-center. Jackson mentions a hemiplegic patient with aphasia who could only utter the words "come on to me," "come on," and "yes" and "no." Bristowe cites the history of a sailor of thirty-six, a patient of St. Thomas Hospital, London, who suffered from aphasia for nine months. His case was carefully explained to him and he nodded assent to all the explanations of the process of speech as though he understood all thoroughly. He was gradually educated to speak again by practicing the various sounds. It may be worth while to state that after restoration of speech he spoke with his original American accent.
