he physiological mechanism of the vocal
instrument of speech, nor to the motor centres in the brain that preside
over its movements in the production of articulate speech. She recognised
pictures and expressed satisfaction or dissatisfaction when correct or
incorrect names were written beneath the pictures; moreover, in many ways,
by gestures, facial expression, and curious noises of a high-pitched,
musical, whining character, showed that she was not markedly deficient in
intelligence. Although in an asylum and partially paralysed, she was not
really insane in the proper sense, but incapable of taking care of herself.
When other patients were getting into mischief this patient would give a
warning to the attendants by the utterance of inarticulate sounds, showing
that she was able to comprehend what was taking place around and reason
thereon, indicating thereby that although stone deaf and dumb, it was
probable that she possessed the power of silent thought. I observed that
during emotional excitement the pitch of the sounds she uttered increased
markedly with the increase of excitement. After having been discharged from
Claybury Asylum she was sent to Colney Hatch Asylum. Upon one of my visits
to that institution I learnt that she had been admitted, and upon my
entering the ward, although more than a year had elapsed since I last saw
her, she immediately and from afar recognised me; and by facial expression,
gesture, and the utterance of inarticulate sounds showed her great pleasure
and satisfaction in seeing one who had taken a great interest in her case.
This poor woman must have felt some satisfaction in knowing that someone
had interpreted her mental condition, for of course, her husband and
friends did not understand why she could not speak. I may mention that the
first attack of loss of speech was attributed to hysteria.

This woman died of tuberculosis seven years after the second attack, and
examination of the brain _post-mortem_ revealed the cause of the deafness.
There was destruction of the centre of hearing in both hemispheres (_vide_
fig. 17), caused by blocking of an artery supplying in each hemisphere that
particular region with blood. The cause of the blocking of the two arteries
was discovered, for little warty vegetations were found on the mitral valve
of the left side of the heart. I interpreted the two attacks thus: one of
these warty vegetations had become detached, and escaping into the arterial
cir