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far it is secondary to the want of brain development or lack of aural functioning cannot yet be determined,
but it is not universally present. The type of speech for instance in Case V. below, was like
that of case VI., the speech of a semi-deaf child, and not like the consonantal defects found in a
child with speech defects in the ordinary school. Dr. Jones found that amongst normal school children
the enunciatorv capacity varied with the degree of nasal obstruction, and therefore presumably with
the deafness, whereas among children with marked speech defects this was in no sense so. Thus
it would appear that grave speech defects in the elementary schools do not depend mainly on hearing
defects, and show a different type from the cases due to congenital (weakness of the word centre)
word deafness, which in part is allied to the cases associated with hearing defect.
Psychical Deafness.—Illustrative case notes are here given from suspected cases which
have been followed up during the past year.
I.—C.H.S., No. 7671, boy aged 8, December, 1907 ; attending M.D. School:—
Other five children normal, except eldest rather backward.
Natural development till 3½. Great fright from being put into cold bath as punishment. Could not
be brought near a bath for two years after without evincing the greatest terror. After this date he began
to gradually lose his speech, was absolute in six months, and continued so for three years. In the past year
began to slowly regain some small phrases— "No, I won't," "Leave me alone," "I'll tell daddie," were
quoted. Talks to infant sister, 2½, lalling in infantile speech to her. Hums tunes correctly. Terrified of
his shadow. Sometimes cannot be got to take food for watching the door lest someone enters. Follows
mother about at home. Terrified of nurses since adenoid operation 3 years ago. No fits of temper. With
loss of speech apparently lost all power of understanding and merely stared when addressed, regaining this
pari passu with speech. Will clear table or answer the door. He is exceedingly timid and nervous and
requires great patience to win any trust. Unquestionably he understands his mother's narrative, following
it with interest. His hearing is normal; he matches colours but cannot read and count. Now has infantile
speech—" mifs " for " miss," Tardie " for "Charlie," " peddy " for " penny," like the infant sister.
In school the boy is regarded as deaf mute and mentally deficient. He has made no progress
and the teachers are unable to get into communication with him. He sits apathetically motionless.
Ten months later Dr. Thomas reports, " He is clearly a case of motor aphasia, the cause being
psychical or hysterical."
II.—L.D., No. 21,432, girl, aged 10, December, 1907 :—
Family history negative. Mother regards her as quite normal, except for lack of speech, and the fact
that she cannot learn at school. She has used short phrases at home. She is clean and tidy and has always
been quite normal in this respect. Well formed child, very timid, hears whisper well, performs simple requests.
No speech could be elicited nor any complicated requests such as counting. A case of motor aphasia in
which, however, the evidence is not clear that the troubles are secondary to psychical disturbance.
III.—D.B., (see Fig. below), girl, aged 11, February, 1908; Deaf School:—
Two brothers and three sisters normal. Three years in centre. Three-years in Deaf school. On admission
had only vowel hearing and could reproduce no words. Apart from hearing and speech, normal, and more
intelligent in work than a deaf child of her age. Frightened and nervous. Relies apparently on lip-reading,
but hears whisper at 5 feet, obeying " Pick up your glove," uttered behind her back ; is, however, very
uncertain and doubtful about all commands. Spontaneous speech slipshod and indistinct, but reproduced
speech quite clear. Using test words and comparing results with lip-reading to those when only hearing is
allowed, there was always a tendency to replace " sh " by " s " much more marked with lip-reading, d and
g and n and 1 are often mistaken too.
Case III. D.B. M—Motor speech centre. LA, LA—Lower auditory centres. A—The undeveloped weak
auditory speech centro. LV, LV — Lower visual centres. LR—Lip-reading centre. I—The seat oi consciousness
diagrammatically represented. Eye, TjV, Lit, /—The most direct route to the understanding of speech (lip-reading).
Ear, LA, M, I—The preferred route to the understanding by the ear. Kar, LA, A, I—The normal route from the
ear to understanding; in this case weak or absent. Ear, LA, M, speech—Echolalia.
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