The discussion bears on four main points : the linguistic characteristics of paroxysmal aphasia as compared to those of aphasias of other etiologies; Pierre Marie's oneness doctrine of aphasia; the mutual relationships of language and thought in aphasia ; the affective experience lived by one with severe aphasia, with special reference to the notion of anosognosia. This is a clinical case report : given the present day philosophy of medical research publication, justification of a sort is therefore desirable. The case is one of paroxysmal aphasia Insert 1 , occurring without modification of consciousness but for tractable initial drowsiness and without any other neuropsychological impairment that we could recognize.
Although paroxysmal aphasia is only relatively infrequent Bancaud, , this double dissociation is indeed exceptional and, together with the semeiological wealth and length of some of the patient's dysphasic episodes, it provided the ground for gathering exceptional observations in relation to several major problems of aphasiology : Since isolated aphasic manifestations could be observed over periods of several hours in the course of some of the patient's transitory attacks, the case permitted diachronic description of a few strictly linguistic aspects of paroxysmal dysphasia and their comparison to those in dysphasias of other etiologies , thus complementing known clinical descriptions of this condition [of which the best we know is the one by Alajouanine and Sabouraud Insert 2 ].
Furthermore, since the patient's linguistic behavior could recapitulate, in the course of a single epileptic spell, the semeiology of several forms of aphasia to which individual labels are usually attributed global, Wernicke's with anosognosia, conduction, amnestic , the case was particularly favorable to reassessment of the oneness doctrine of aphasia [of which, in our opinion, the clearest formulation by far remains Pierre Marie' s ].
Finally, since the patient could and did resort to standard thinking-speaking abilities, between aphasic paroxysms, in order to think and speak of a repetitive personal experience of [isolated] aphasia comprising a phase of "anosognosia", the case naturally -- indeed ideally -- led to reconsidering a the problem of the mutual relationships of language and thought in aphasia Alajouanine, ; Lecours, Lhermitte, et al.
After a circumstantiated report of our patient' s neurological history, we will discuss each of these four problems in turn. Such spells are usually of brief duration, lasting only a few minutes. Nonetheless, paroxysmal dysphasic episodes of longer duration and comprising more complex manifestations of linguistic dysfunction can occur. In such cases, Alajouanine and Sabouraud describe a an initial "critical phase", lasting 3 to 5 minutes at the most, massively involving language expression and comprehension the way global aphasia does, and concomitant to maximal electrical discharge as witnessed by the scalp EEG; it is followed by b a "postcritical phase", lasting from minutes to hours, comprising a cluster of regressive dysphasic symptoms and signs usually akin to one form or another of Wernicke's aphasia with anomia being the most common, apparent, and persistent deficit , and resulting in relatively little if any scalp EEG anomalies.
Being intellectually inquisitive, he has kept learning since then in the manner of an autodidact.
Reading and writing have been part of his daily adult life. For the past decade or so, he has worked on the editorial staff of his order's pious periodical, his main job being to read and answer letters to the editor up to 55 a day. He considers himself utterly untalented with regard to apprenticeship of foreign languages : indeed, he remains very much of a French unilingual although he has been intensively exposed to both Italian and English for long periods.
Brother John has now presented epileptic spells for more than 25 years. He reports no past history of head trauma and, but for his epilepsy, has always been clinically healthy. As several other members of his family, he has long been known to have hypercholesterolemia; his family history is not otherwise pertinent. In the course of the past 5 years, we have often had the occasion to question and listen to Brother John, to observe and examine him between and during spells. Brother John perhaps presented a first episode of "grand'mal" at age 15, a few hours after receiving local anesthesia for dental extraction.
He certainly presented two or three such episodes, at age 20, while on a trip. He was then seen by a physician and told he was epileptic. He has taken different drugs ever since, including phenobarbital, diphenylhydantoin Dilantin , carbamazepine Tegretol , and primidone Mysoline. From then till now, "grand'mal" has recurred only once or twice, but he has regularly presented focal spells the clinical manifestation of which has always been isolated dysphasia. These spells have been of two types : short and long.
Should this frequency increase, Brother John will suspect that a long spell cf. When a short spell takes place, the patient feels bizarre and keeps very quiet; he does not understand spoken language, and he cannot or at least he does not talk; a great many such spells having occurred while he was at his desk, answering the journal's mail, Brother John knows for sure that his reading-writing abilities are then suppressed or hampered. The dysphasic semeiology of short spells, in this patient, is therefore similar to that described in the well-documented case of Boudouresques, Roger, and Gastaut The patient believes that most deflections from a sedate and virtuous life are potential triggers of a long spell.
A typical long spell will follow one of two schedules: a Either it begins with word-finding difficulties and gradually progresses to a phase of suppression or near suppression with maximal impairment of language comprehension. The latter takes place at about midspell and the intensity of dysphasia thereafter gradually decreases, with word-finding difficulties being the last immediately apparent anomaly to taper off. Or else b , soon upon waking time as a rule, paroxysmal dysphasia opens on suppression or near suppression with maximal impairment of comprehension, and the evolution thereafter takes place as above.
One thus recognizes, at least in the latter pattern, the ictal-postictal dissociation described by Alajouanine and Sabouraud In the case of a protracted episode, this usually means feeling more and more dejected after a while, sometimes bitterly weeping over mental isolation.
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It also means, whatever the duration of the episode, being aware of specific perturbation in spoken and written language comprehension and production although the patient does not know right off if a given attempted utterance or written production of his is adequate or not.
The latter becomes dramatically obvious when the patient syntonizes a tiny transistor radio, carefully kept within hand reach, in deliberate assessment of his oral comprehension capacities; or else, when he goes to his office and looks at the mail to find out if he "can work". Whatever the case, the arthric perturbation tapers back to normal over a relatively brief period about half an hour , somewhat ahead of reduction itself. The following is an example : l "[gli gliari ari ari ari gliari tylary ary glafy] Je sais pas. Le [f] J'ai euh The following exemplifies the production of the predilection neologism in attempts at naming during the jargon phase : 2 The patient is shown a picture of a telephone.
La [furi twar]. Non, [lf tuware tu tylari] Non, [tu:uru] Pas capable.
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The jargon will recede in turn, after 1 hour or so. In the process, there can occur a phase during which manifestations of word-finding difficulties and production of phonemic deviations, sometimes with attempted corrections, dominate spontaneous oral production.
Elle se Elle s'en venait par Elle se vanait Elle s'en venait [mar] S'en venir ici : la! The following are examples of the latter : 5 The patient is shown a picture of a chair. He first says that he is sitting on one : "Une Brother John laughs and the examiner utters the initial phoneme : une [S] Euh [SOnte]. C'est pour s'asseoir The examiner provides contextual facilitation : Je m'asseois sur une Je m'asseois sur une chaise!
J'ai le : [s sy syml syml]; [syml]? La semelle d'un Somehow, Brother John is aware of the latter since he then spontaneously resorts to paper and pencil rather than talk. In early phases, Brother John is likely to make errors even in attempts at writing his own name. All types of written output are then involved, copy included, e. As shown in Figure 2, writing to dictation leads to production of numerous literal paragraphias, e.
In the following sample, dictated 4. Les equipes de secours ont perdu tout espoir de retrouver des survivants. Oral spelling is proportionally impaired throughout, e. With regard to written expression, a gradually receding dysorthographia will be the last anomaly to taper away. Indeed, dysorthographia and word-finding difficulties are, and by far, the last evidences of dysphasia to clear : their complete cessation indicates, in other words, the end of Brother John's long spells. Comprehension of both spoken and written language are massively impaired at peak of spell in earlier phases, the patient cannot even tell spoken or written French from a foreign language .
This perturbation remains obvious until and through the jargon period. It progressively decreases thereafter, usually with a detectable gradient in favor of written comprehension. In oral pointing tasks, we have once noted errors to be somewhat more frequent in the case of morphologically related linguistic stimuli than in that of semantically related ones. Finally, comprehension of both oral and written language are grossly normal at a time when dysorthographia and dysnomia word-finding difficulties are still manifest Figure1.
Given a restrictive definition of internal language as the capacity of any normal speaker to talk to oneself -- silently and privately -- in words and sentences formally akin to those used in public expression Sokolov, , Brother John reacts with two main comments : on the one hand, inner and overt expression are proportionally affected throughout his dysphasic spells; on the other hand, coherent thought remains possible in the presence of dysphasia affecting inner as well as overt expression, i.
He provides examples of the latter. In relation to the day when one of us had driven him to the hospital in the course of a long spell free translation : "I could not tell you more than I could tell myself but I somehow knew that someone should have informed the janitor that I was leaving the convent; I could think clearly within my inner self but, when it came to [silently] talking to myself, I experienced difficulty finding my words.
As to his first comment above, it requires further qualification : when Brother John claims adequation between inner and overt dysphasia, he essentially speaks of word-finding difficulties disponibility or lack of disponibility for public use is in a one to one relationship to disponibility or lack of disponibility for private use, whatever the type of production, e. It should be noted that this patient does not do better with repeating and reading numbers aloud than he does with words. From then until the end of the episode, imitations of gestures of the examiner, and later their execution following linguistic command, were found normal whether these gestures were simple or relatively complex, appendicular or axial mouth and face included , unilateral or bilateral, arbitrary or semantically loaded.
Moreover, he remains capable, throughout his spells, of spontaneous actions such as operating an elevator, tuning a radio, using a tape recorder i. From then until the end of the episode, such tests none pertaining to verbal deafness or blindness did not evidence agnosia in the tactual and visual spheres : nonlinguistic tactile and visual stimuli were properly recognized whenever they could be paired with images or associated to gestures, and some were simply named; although a few nonlinguistic auditory stimuli apparently puzzled Brother John including the noise of a typewriter, with which he is familiar, the neighing of a horse, and the grunting of pigs , most auditory stimuli were also unambiguously recognized.
Furthermore, the patient recognizes -- but as a rule cannot name -- known people he sees when dysphasic, as well as he recognizes, as witnessed by proper use, daily life objects such as comb and shaver, soap and towels, clothes, utensils and crockery, and so forth. He has been reported to listen to instrumental music during his long spells and says the latter do not diminish his uneducated capacity to appreciate music and recognize -- but for their names as a rule -- known melodies.
He rightfully states himself capable of recognizing unseen familiar persons by listening to their voices a nurse talking in the corridor, for instance or even steps a colleague who walks with a cane, for instance , although he can be utterly incapable of evoking their names, either for private or for public expression. In places he has never been before, he will behave normally as long as he does not have to rely on linguistic information, spoken or written. He once had difficulty finding his way in Montreal and later explained : "I knew where to look for the names of the streets, I could see them but I could not read them" free translation.
MEMORY -- Brother John remains capable, throughout long spells, to remember events -- linguistic or otherwise -- that have occurred previously. He will therefore carry out, in the course of a dysphasic episode, verbal instructions given days or weeks before : without being capable of any linguistic recapitulation, inner or overt, he has thus carried on with instructions such as sampling his own deviant speech on magnetic tapes, attempting to write a few words at peak of spell, alerting a third party in order to have one of us informed of the occurrence of a severe dysphasic episode.
He did the latter a few times by presenting the third party with a previously written note comprising explanations and phone numbers. On the other hand, and although he is anosognosic for particular linguistic deviations cf. THOUGHT -- When Brother John managed to inform us through a third party, he knew about the meaning of his previously written note, he knew that we would thereafter learn by telephone that he was being sick, and he knew that one of us might come to visit, examine, and test him. When he had to answer the telephone during a spell, he kept repeating "Allo!
When he had visitors during a dysphasic episode, he saw to it that one of his colleagues, already informed of the expected visit, understood he was to replace him beside his friends, guide them to the convent's cafeteria, and entertain them through dinner time. In other words, the occurrence of a dysphasic episode does not prevent Brother John from thinking clearly in relation to co-occurring concrete situations, neither does it prevent him from confronting present to past events, planning accordingly, and acting at best.
In this respect, the following anecdote is strikingly demonstrative and, in our opinion, it compels assent as to the language specificity or near specificity of our patient's paroxysmal episodes as well as to his state of mind and mental capacities in the course of such episodes : While he was traveling by train from Italy to Switzerland, Brother John once found himself at the height of paroxysmal dysphasia soon upon reaching the small town of his destination.
He had never been in this town before but he probably had considered in his mind, before the spell began or became severe , the fact he was to disembark at the next stop of the train. At all events, he recognized he had arrived when the time came. He consequently gathered his suitcases and got off the train and out of the railway station, the latter after properly presenting his transportation titles to an attending agent.
He then looked for and identified a hotel, mostly or entirely on nonlinguistic clues since alexia was still severe, entered and recognized the registration desk, showed the attendant his "medic-alert" bracelet only to be dismayed and dismissed by a gesture meaning "no-room" and a facial mimic that perhaps meant "I-do-not-want-trouble-in-my-establishment".
Brother John repeated the operation in search of a second hotel, found one and its registration desk, showed his bracelet again, and, relieved at recognizing through nods and gestures that there were both room and sympathy this time, he gave the receptionist a "fat lady" his passport, indicating the page where she was to find the information necessary for completing his entry file. He then reacted affirmatively to her "do-you-want-to-rest-in-bed-now'' mimical question. He was led to his room and given his key; he probably tipped as expected and went to bed.
He did not rest long, however: feeling miserable ["It helps to sleep but sometimes I cannot because I am too nervous and jittery" free translation ], then hungry, he went down to the hotel's lobby and found the restaurant by himself. He sat at a table and, when presented with the menu, he pointed at a line he could not read but expected to be out of the hors-d'oeuvres and desserts sections.
He hoped he had chosen something he liked and felt sorry when the waiter came back with a dish of fish, that is, something he particularly dislikes. He nonetheless ate a bit "potatoes and other vegetables" , drank a bottle of mineral water, then went back by himself to his room, properly used his key to unlock his bedroom door, lay down, and slept his aphasia away. He woke up hours later, okay speechwise but feeling "foolish" and apologetic. He went to see the fat lady and explained in detail; apparently, she was compassionate. Neurological examinations have remained normal between full blown spells.
Exhaustive aphasia testing has been carried out on several occasions between full blown spells. The results of these tests, nonetheless, compared to one another, have twice shown a minimal deficit in naming mostly latencies and a mild degree of dysorthographia, leading mostly to production of literal paragraphias by regressive or progressive assimilation of a letter, e. Brother John was aware of this on both occasions and he spontaneously attributed his difficulties to weariness. Indeed, he has a name! He comments that the latter might be an effect rather than a cause.
Brother John has undergone extensive psychometric testing between spells. A certain discrepancy was found between Wechsler's verbal and performance intelligence scales, somewhat unexpectedly in favor of the former VIQ: ; PIQ: , and also between Wechsler's intelligence and memory scales IQ: ; MQ: Obtained at times when aphasiological and routine neurological examinations were normal, these results were considered to be consistent with organic brain damage. Simple skull X rays and y-encephalograms were normal.
CT scans showed the left lateral ventricle to be slightly larger than the right one, with both sylvian fissures visualized, symmetrical and normal; these images were interpreted as being within normal limits, showing in particular no evidence of a space-occupying lesion. Electroencephalograms were recorded on several occasions since : standard recordings were always normal between spells; sleep recordings between spells evidenced focal epileptic activity of the spike-and-wave type, maximal over F7-T3 standard electrode placement ; recordings in early postictal phase, while the patient was awake and still severely dysphasic, showed slow waves and a few spikes over the left hemisphere, with maximal anomalies over the anterior and midtemporal regions, and spreading to posterior temporal, frontal and, to a lesser degree, centroparietal regions.
They include phonetic distortions that are sometimes akin to those linked to the paretic phase of the phonetic disintegration syndrome Alajouanine et al. In clinical aphasiology, it is not uncommon to observe patients with global aphasia -- usually the result of a CVA or trauma -- whose evolution is such, as to improvement of oral comprehension, that the original label can be changed to that of Broca's aphasia after a few weeks or months if one does not insist on having the patient submitted to comprehension tests above the elementary level : after all, this was almost certainly the case of Paul Broca's famous Monsieur Tan  Broca, Be that as it may, and whether one does or does not have the habit of reconsidering labels with time passing and behaviors changing, the succession of events observed in the course of Brother John's long spells, from the jargon phase until the end of the episode Wernicke's then conduction then amnestic , is comparable to that observed in many a patient displaying favorable evolution after a CVA or trauma responsible for left temporal damage.
Favorable evolution of conduction to amnestic aphasia, usually after an embolism to the left supramarginal region, is also well known.
- Parent topics.
- Pourquoi faire un don ?.
- Prisoner To Poet: Thoughts Of An Incarcerated Soul?
This is the delightful little Fun Alive O! Or the Merry Mortals Companion London: [? Our biblioweatherreport for the first day of Spring and marbledmonday : the oh so moody looking marbled endpapers for Fun Alive O! Or the Merry Mortals Companion London, [? Yes, the sky is just as moody here as we wait for the rain. We have three copies, all of which are different and beautiful; this is copy three, and its text block is wrapped in blue, yellow and white marbling, inside a dark blue morocco binding. It's interesting to see how three different owners treated the binding of this particular title, all of them specially done, since Aldus and his successors are not known for providing bindings with their finished publications.
An end of the month post for justtheticket February challenge, sponsored by robbinslibur and americanantiquarian. This has got to be one of the most interesting themes we've participated in, showing off booksellers' and bookbinders' tickets or labels. Here's our last ticket post March starts a new challenge: look out for it! Blue paste paper end papers, with the bookseller's ticket very neatly glued to the upper corner inside the front cover.
Thanks, everyone! Lubbock at your service. William Lubbock, bookbinder, was situated in St. Nicholas' Church Yard, "adjoining the Premises of Mr. Bewick" in Newcastle Upon Tyne, a large enough town to maintain five resident bookbinders. This neatly printed binder's ticket is to be found on the front pastedown of the equally neat blind sprinkled leather and gold tooled binding, probably done between Fun in the stacks! Hughes, by Hamblin, 63 Upper Thames-street, It's interesting to note that the binder recognized the importance of retaining the original printed paper wrapper; it's bound in at the end!
Each volume of this annual is decorated with a specially made marbled paper cover, with leather spine. Our volumes come with extras: broadsides, prints, etc. This design has us thinking of floating butterflies. This marbled paper reminds us of the assembling clouds interspersed with bits of sun, between bouts of showers all weekend long and into the new week. And we've been stepping into giant puddles everywhere! We showed one of the type ornaments two weeks ago. A foreedgefriday post trying to make up for some pretty stormy weather outside.
This blue-stained volume of Cicero's Epistolae ad Atticvm Venice, was printed, with corrections by Paulus Manutius. The simple decoration of staining the fore edge - the Aldine Press seems to have favored blue - is at once beautiful and economical. AldinePress Venetianprinters PaulusManutius foreedge grabhorncollection sfplbookarts sfpubliclibrary iglibraries sfplmarbling - 2 years ago. Collected by Alphonse Esquiros , and published in Paris [? We never got past the marbled papers, they are that mesmerizing! We'll be back on Tuesday. As we make our way through the cataloging of the Aldine Press collection we continue to discover volumes with some beautiful marbled paper designs.
Here's one from Francisci Priscianensis Argumentorum observationes in omneis Ciceronis epistolas; printed in Venice by Paolo Manutio, son of the great Aldus Manutius . Looks like the only sunshine we're seeing today is the yellow of this marbled paper! It's marbledmonday and we're featuring the marbled end papers from Manuscripts, Inscriptions and Muniments Williams was probably better known as the physician who promoted the "twilight sleep" concept of painless childbirth.
He was an author of books on medicine, science, and history.
Virtual International Authority File
Where did he ever find the time? Oh, that's right, no television or Internet. HenrySmithWilliams marbledpaper marbledendpapers RichardHarrisonCollection sfplbookarts sfpubliclibrary iglibraries sfplmarbling - 3 years ago. Dilly, etc. A popular travel narrative of the day, Carver's account went through sixteen editions and was translated into Dutch, French, and German.
Interesting side note: Carver seems to have been a bigamist, having a wife and family in Massachusetts, and another in London. This wonderful orange marbled book cover jumped right out from the shelves for marbledmonday. The marbled paper was made by Richard J. Swirling marbled endpapers decorating another Aldine Press production. Edited by Antonio Manuzio. Marbled endpapers for Les Savetiers, printed by Firmin Didot When we took a marbling workshop a few months back, we learned just how much fun and how much of a challenge!
This feathered pattern is made using a comb or rake drawn across the the colored bath. The hardest parts: getting the right mix of colors and picking up the paper without making a mess of the finished marbled pattern. We have a greater appreciation of this ancient art! Two weeks ago we posted the fore edge and partial red leather binding of Pietro Bembo's Rime Rome, ; now the marbledendpapers for this handsome volume. A calm and soothing marbledmonday before Election Day. PietroBembo grabhorncollection sfplbookarts sfpubliclibrary iglibraries sfplmarbling - 3 years ago.
This beautiful two-color ghostly marbled end-paper thanks emkay49 and iglibraries! According to Robert Grabhorn's notes he was the former owner , this incunable, Aureum Repertorium Biblia by Anthonius Rampligolis Nuremberg: Friedrich Creussner, was probably bound by eighteenth century English bookbinder Roger Payne. What a pattern: almost like it was hit by lightning, not to mention its ghostly aura.
Wands, He probably could have used a good dictionary, too. This little book was thought for a long time to be the first to show the symbol of the American dollar bill sign in print, a somewhat controversial claim in recent years. Published by the venerable J. Dent and Sons These colorful marbled endsheets give quite an introduction to Writing Improv'd, or Penmanship Made Easy by John Clark , for marbledmonday. Trying to get last week out of our head.
It's a moody marbledmonday here in San Francisco, with hints of rain and marbled paper to match. The clean up is almost as beautiful as creating marbledpaper designs! At the end of the workshop day and after students made dozens of marbled papers, the trays are emptied. What is left at the bottom is a rainbow of colors. Something we usually don't see on a marbledmonday.
Marbledmonday report-back: part of the marbling process includes the algae bath to receive the colors, sprinkling the colors, creating the design, laying down the alum primed paper, and voila! This is part of the preliminary show and tell from yesterday's workshop with Pietro Accardi sanfranciscocenterforthebook.
For some of us, it took all afternoon to come up with a decent pattern or two, but we forged on. A day full of creative energy and serious fun, and more information to add to our marbling arsenal at the library. So much fun! We'll report back with more marbled delights on marbledmonday. It's a Lactantius kind of day, with touches of Zaehnsdorf. This is the pictorial binder's stamp on the lower cover of the Divinae Institutiones by Lactantius in two volumes , printed in Venice at the Aldine Press Binding done at the Zaehnsdorf Bindery, well after the founding of the firm in We're not blue on this marbledmonday!
A shoebox full of marbled edges! All snug and waiting to be cataloged on a marbledmonday. The end papers of volume 1; we love how they swirl and move through volume after volume.
Not all patterns are the same, which makes this set even more interesting. This marbled paper matches the moodiness of today's weather; used as the cover for Le Martyre de St. Eustace by Desfontaines Paris: Toussaint Quinet, For marbledmonday we present the swirling endpapers from Nobilta Veneta , the fore edge of which was shown last week, with a brass and leather clasp.
This little guide book to the nobility of Venice includes coats of arms and engravings of some of the powerful and elegantly dressed movers and shakers, such as the Doge and Dogaressa, oh, just walking around and doing errands. The tourist reader might have taken a seat in the middle of Piazza San Marco to try and spot Venetian celebrities. This is the copy owned by English botanist John Stackhouse see our previous accidentalbookmark post. This San Francisco printer collected examples of printers' works from the late 15th century onward, to better understand and learn their printing techniques, which informed and enriched his own printing at the Grabhorn Press run with brother Edwin.
Related La Redoute des contrepéteries (French Edition)
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