No. 2904.

APRIL 26, 1879.

Lumleian LecturesON THE

PATHOLOGICAL RELATIONS OF THE VOICEAND SPEECH.

Delivered at the Royal College of Physicians, London,

BY J. S. BRISTOWE, M.D., F.R.C.P.,SENIOR PHYSICIAN AND JOINT LECTURER ON MEDICINE,

ST. THOMAS’S HOSPITAL.

LECTURE II.—PART I.

MR. PRESIDENT AND GENTLEMEN,-In my last lectureI discussed the mechanical and acoustical principles of thefunctions of voice and speech. I pointed out the funda.mental importance of the chest and its contents as a col-lective organ for the regulated discharge of air over thevibratile vocal cords and through the articulating cavities oithe mouth and nose. I considered briefly the action of thelarynx: first, in allowing the escape of silent breath ;second, in imparting to the expired air that toneless flutteiwhich is the basis of whispered speech; third, in the pro.duction of the musical sounds of the natural voice ; and,lastly, in the causation of falsetto notes. And, in conclusion,and at much greater length, I discussed the means by whicbarticulate sounds are uttered, the various characters of thesesounds, and their mutual relations.The complexity of the combined processes concerned in

phonation, and dfortiori of those concerned in articulateutterance, is confessedly very great. It is remarkable,even if we regard it from the point of view of the numberof separate parts whose co-operation is needed for their dueperformance. But from this point of view the simple reospiratory mechanism would seem more complicated than themechanism of the larynx, and the latter more complicatedperhaps than that by which articulation is effected. Thereverse of this, however, is undoubtedly the fact; and,indeed, but little consideration is required to make it clealthat complexity of mechanism and multiplicity of parts areby no means correlative conditions. The variations in the

capacity of the chest, on which inspiration and expirationdepend, are due simply to the alternate actions of antago-nistic groups of muscles under the influence of special groupsof nerves. And although the thoracic framework is of com-plex structure, and the muscles and nerves which determineits movements are very numerous, and apparently highlycomplicated in their arrangement, the entire mechanism iof such a character, and the combined movements of whichit is capable are so few and simple, that it should be an easyproblem to collect, so to speak, into the hands of some cen-tral power the strings by which the various co-operant partsmay be brought into harmonious action. Indeed, the re-

spiratory acts, notwithstanding the extremely delicategradations of force of which they are susceptible, and theirmarvellous precision in association with speech and music,constitute one of the simplest examples of co-ordinatedmovements. Their co-ordinating centre is well known to besituated in the medulla oblongata ; but this (for the purposesof speech and voice) is clearly under the influence, or theagent, of some higher co-ordinating centre, which brings itsactions into due relation with those of these associatedfunctions.The movements of the larynx, again, despite the perfection

of its mechanism and the infinite series of graduated soundsto which it may be adjusted, are only in a slight degreemore complicated than those of the thorax. They consistessentially in the opening and closing of the glottis and thestretching and relaxing of the vocal cords ; the latter actions,on which alone the variations of the pitch of the voicedepend, being determined simply by the regulated contrac-tion of certain groups of muscles. It is clear, then, in thiscase as in the last, that apparent complexity becomes onanalysis comparative simplicity, and that the co-ordinationof the laryngeal movements for song and speech, as a motorproblem, presents but little difficulty. The centre for the

combined movements of the larynx is seated in the medulla;but it is obvious that for the utterance of notes in musicalsequence it is subordinate to some centre of higher attri-butes.The muscular actions on which the production of articulate

sounds depends are different from either of those groupswhich have just been considered, inasmuch as, while theyseem to demand less nicety of adjustment in the contractionof the different muscles engaged, they involve a much widerrange of motor combinations. That less nicety of muscularaction is required for speech than for phonation, or for theregulation of the discharge of air from the lungs, seemsobvious when we consider how in the one case the forcewith which the air is expelled has to be adjusted accuratelynot only to the different degrees of loudness of the voice,but to the different degrees of obstruction occurring in thelarynx and mouth, and how in the other case the minutestvariations in the amount of force which the muscles exertupon the vocal cords are attended with appreciable differ-ences in the pitch of the resulting notes ; while the differentarticulate sounds, though requiring special arrangements ofthe organs of speech, admit, within certain limits, of muchvariety in the details of these arrangements. But that theyinvolve a much greater variety of motor combinations isquite certain. For while the actions of the thorax aresimply those of inspiration and expiration, and those of thelarynx, so far as mere phonation is concerned, simply relateto the more or less tension of the vocal cords, every singleliteral sound or element of spoken language is characterisedby a specific arrangement of the organs of speech. Thenumber of these distinct motor combinations, however,is much less formidable than might at first sight besupposed. It will be recollected that in my last lectureI enumerated fourteen distinct vowel-sounds as existing inEnglish, and half a dozen more which are special to certainother European languages, together with twenty-four dis-tinct consonantal sounds characteristic of our mother tongue,and about five others of foreign birth. I do not by anymeans intend to imply that these forty-nine distinct soundsinclude all possible articulate sounds, or even all thosewhich competent authorities recognise among Europeanlanguages ; or that there may not even be, as some assert,articulate sounds in our own language to which I have givenno place in my scheme. But I am satisfied that the specific-ally distinct articulate sounds in the English, and probablyin any other language, are, at any rate, under fifty. If,indeed, we eliminate the surd letters, which, so far as theiroral manufacture is concerned, are identical with theirseveral sonant varieties, the articulate sounds of our ownlanguage become reduced to twenty-nine. It is certain,however, that the exercise of speech as an art involves muchgreater difficulties than the mere distinct utterance oftwenty-nine, or even fifty, different sounds. Letters have tobe associated in words in almost endless combinations, andthe passage from the position of the organs for one letter tothat of their position for any other letter has to be effectedwith readiness and precision. The difference, in fact,between the mere capability of uttering so many differentletters and the art of readily combining them in speech isvery much the difference between simply striking solitarynotes of a musical instrument with the finger and the playingupon them in orderly sequence by the hand of the skilledmusician. That the centre for the co-ordination of thosemovements of the mouth, tongue, and fauces which are con-cerned in mastication and deglutition is situated, with thosefor respiration and the ordinary actions of the larynx, in themedulla oblongata, is doubtless true. But it is at leastprobable that the centre for the co-ordination of the move-ments concerned in articulation is situated in some differentand higher part of the encephalon, probably the corpusstriatum. At the same time, there are many reasons forbelieving that the superior centre for spoken language-thecentre whence the impulse to express our thoughts in wordsstarts-is only indirectly concerned in the co-ordination ofthose groups of movements which by their sequential as-sociation determine speech. In other words, it seems pro-bable that, when the mind wills to express itself in articulatelanguage, it effects its object automatically-not by actingdirectly from the speech-centre on the nerve-nuclei of thenerves distributed to the organs of speech, nor even on theco-ordinating centre for the simple acts of mastication anddeglutition, but on some other centre which governs thespecific movements for the utterance of articulate soundsand their facile combination.

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I have thus far considered, imperfectly I admit, the pro- further, that concurrent acoustical impulses from differentcesses by which intellectual and musical conceptions and sources produce in the membrana tympani apparentlyrecollections arising in the superficial grey matter of the tumultuous oscillations, which are, in fact, the mean

cerebral hemispheres become expressed respectively in of all the motor influenees which are acting upon it.spoken language and vocal music. It may be interesting, We know, in the second place, that the impulses which(Ja the other hand, to consider briefly the converse processes affect the membrana tympani are imparted through theby which .musical and articulate sounds are conveyed to the chain of ossicles and fenestra ovalis to the perilymph, andsupreme centres for the reception and cognisance of acoustical thus still blended and apparently confused sweep over theimpressions. The modes in which the peripheral ends of keys of the cochlea. I am not aware that it is even yetthe sensory nerves receive impressions, and these impressions known positively how soijorotis impulses affect the peri--are conveyed to the central organs, and thus become modified pheral terminations of the auditory nerve ; but, at any rate;.into perceptions, are doubtless in many respects identical. there are, in the anatomical details of the cochlea, and inIt will be allowable therefore to argue from the eye, as the analogies afforded by the other senses, good grounds forthe batter-understood organ, to the ear as an organ the the belief that every series of simple musical vibrations isfunctions of whose parts have scarcely yet been clearly deter- caught up, as it were, by its own special portion of the:mined. The peripheral ends of the fibres of the optic cochlear mechanism, and carried thence by a particular-nerves appear each to be connected with a special end-organ- nerve or group of nerves to some part of the central nervousa rod or cone,-which is adapted to receive and transmit apparatus. If this view be correct, every compound vibra-impressions due to the rays of light which impinge upon it. tion, every group of compound vibrations, which falls uponWe have no reason to think that any one of these end-organs the membrana tympani, and is carried thence in a concretedoes more when exposed to its proper stimulus than receive form to the essential parts of the ear, becomes there analyseda single impression of light of a certain quality and intensity, and reduced to its simplest elements, each of which isor individually transmit to the sensorium anything beyond carried separately along its particular route to the sensorium;that single formless and limitless impression. The know- there to be reunited with its fellows into a single specineledge which we derive through the eye of the size and shape perception.and other visual attributes of objects depends upon the The object I have had in view in making these latterfact that cones of light emanating from minute yet definite remarks has been to show that, just as when we will thepoints of their surface are brought individually to a focus by performance of some special act (say the utterance of athe optical arrangements of the eye upon the ends of appro- word) the concrete impulse which alone exists in the brainpriately situated rods and cones. The retina, in fact, is a is transmitted along special fibres to special co-ordinatingmosaic of which each element receives a single elementary centres or agents, from these to a wider range of subordinateimpression, which, taken alone, has no meaning or signi- centres, and thence to the innumerable nerve-fibres whichficance beyond the fact that there is light of a certain act directly and in due proportion on the various muscles,intensity and colour, but which, taken in connexion with whose duty it is in combination to perform the specific dutythe simultaneous impressions made on the artilicially ar- required of them, so conversely the objects of our sensations,ranged elements which surround it, carries to the mind which are presented in a concrete form to our organs ofsimultaneously, but piecemeal as it were, an accurate re- sense, are analysed by them with extraordinary minuteness,presentation of the picture formed on the retina. That is are carried with infinite subdivision by the correspondingto say, the picture of any object which impresses itself on sensory nerves to their nuclei of origin and to co-ordinatingthe mind as a concrete whole, and which is only resolved centres, whence they are transmitted to the sensorium, whereinto its simpler elements by a mental effort, is actually in again they concrete into a single picture or perception-its progress to the sensorium divided by the retina into in- where the unravelled threads of sensory impressions arenumerable bits, and carried inwards in innumerable distinct again woven into the patterns from which they were

streams, of which individually the mind has no separate derived.cognisance, but which collectively produce a compact im- I ask pardon for whatever in the foregoing observationspression or perception. It is doubtless essentially the same may appear to be trivial, irrelevant, or erroneous. Iacknow-in regard to the transmission of auditory impressions. But ledge that some are crude, and that I have been temptedhere geometrical relations become unimportant, while those here and there to diverge into discussions which I shouldof time and the qualities of the impressions rise into special probably have done well to avoid. Still, there are, I trust,importance. The vibrations which produce sound are waves some things among them which will be found to have a moreof alternate condensation and rarefaction. Those which or less direct relation to those pathological questions whichcause musical sounds are rhythmical, the pitch of notes I now proceed to consider.being directly proportional to the rapidity with which the 1. The first of these which I had proposed to myself hasvibrations follow one another. The different qualities of already been adverted to by my friend, Dr. Stone, in hismusical sounds depend on the association with the funda- suggestive Croonian lectures-I mean the subject of themental vibrations (or those which determine the pitch of auscultation of the voice and speech. I have hesitatednotes) of rhythmical vibrations of greater rapidity which are whether, under the circumstances, I should introduce itin harmonic relation with them ; and these associated groups here, but, for reasons which 1 need not specify, reconsidera-of vibrations differ largely in relative intensity, and in tion has decided me to adhere to my original programme.number in different cases. So that definite musical notes, Bronchophony, pectoriloquy, and aegophony, are the nameswith their associated harmonics, present in many cases ex- which are applied to the different varieties of sound, due totreme complexity. As regard sounds which are not musical, articulate and vocal utterance, which reach the ear of theno definite rule can be stated of them, except that they are listener, applied directly or through the intervention of thedue to vibrations, which may be solitary, or, if grouped, are stethoscope, to the chest. The meaning of aegophony isirregular in sequence and loudness, or are rhythmical but well understood. It signifies a tremulous or bleating high-follow one another too slowly to become blended into a pitched modification of bronchophony, generally audible inmusical note. It will be recollected, moreover, that many cases of moderate pleuritic effusion over the lower part ofsounds, like those of articulate utterance, which are not the back of the chest. It is, as Dr. Reynaud holds, "merelynecessarily musical, owe their distinctive qualities to groups a remote bronchophony," and its peculiarities are due, as

of resonances or harmonic tones which their fundamental Dr. Stone has, I think, distinctly shown, to the fact thatsound, be it what it may, wakes into being. Now, how are from some special causes interfering with the uniform trans-these groups of variously compounded vibrations, which mission of sound (in pleuritic effusion to the presence of aeven the comparatively uneducated ear distinguishes as the layer of fluid between the lung and chest-wall), the deeperproduct, in one case of the harp, in another of the organ, in and coarser vibrations of the fundamental tones of the voiceanother as a literal sound, and in yet another as the voice of are arrested in their transit, while the finer and closer undula-a friend or relation, absorbed, so to speak, by the essential tions of their harmonics filter through, and either alone orparts of the ear ? How are they carried to the sensorium ? 1 mainly reach the ear of the auscultator. But what are theAnd how do they there become or produce those concrete meanings of the terms bronchophony and pectoriloquyperceptions which reveal their several sources ? We know, Most practical physicians profess to know, and yet I makein the first place, that every impulse or wave which falls on bold to say that scarcely anywhere will be found an intelli-the membrana tympani produces a corresponding backward gible, or, at any rate, accurate, statement of the distinctionsand forward movement in that membrane, that every which, I think, undoubtedly exist between them. Thatmusical wave, with all the subordinate waves which ac- Laennec himself recognised a clear practical difference be-company it, are accurately represented in its vibrations, and, tween pectoriloquy and bronchophony few, I should think,

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can doubt. At the same time his descriptions of these con- peculiarly characteristic; low, mumed whispers pass directlyditions are so confused that after perusing them one is into the ear, articulated sometimes with as much, if not

tempted with Skoda to assume that "Laennec’s pectori- more, precision than the laryngeal voice." He says else-

loquy and bronchophony represent one and the same phe- where of laryngophony, to which he compares pectoriloquous.uomenon." His descriptions, however, are evidently vitiated bronchophony, that the voice is transmitted impC1jGctllJbv two facts-one being that from a very early period he ccrticulccted; and of natural bronchophony, of wl-ilch broii-adopted the theory that pectoriloquy is heard only over cavi- chophony in disease is simply a variety, that the articula-ties, and is due to the resonance of the voice in cavities, tion is very imperfect; showing apparently (as is confirmedwhile bronchophony is developed in the course of tubes ; the by his selection of names) that in his view pectoriloquy andother being that he had no clear conception of the essential bronchophony are mere grades of the same phenomenon..distinction which there is between simple laryngeal intona- The only other writer to whom I shall refer is Dr. Gee,tion and the articulate utterances of the mouth and associated who, in what, on the whole, is a very good account of theseparts. He consequently had a tendency to call all those conditions, observes that pectoriloquy is nothing but a veryincreased vocal resonances which were heard over presumed clear bronchophony, and who evidently, therefore, likecavities pectoriloquy, and all those which were audible over Walshe, Skoda, and many others, seems to regard pecto-solid lung permeated by tubes bronchophony. And his de- riloquy as being acoustically the same thing as bron-scriptive difference between the two conditions amounts chophony, but as bronchophony in its most perfect form,simply to this-that in pectoriloquy the voice appears to or the sound of the voice as it is heard normally over thecome directly from the chest, and to pass wholly through larynx.the central canal of the stethoscope, while in bronchophony Now, I cannot venture to say that I have done fullthe voice seems to pass only in part through the stethoscope. justice to the accounts which the eminent writers I haveIt need scarcely be said that his theory was wrong, and that quoted have given of pectoriloquy and bronchophony;his descriptions as they stand are inaccurate and fanciful. there is much in what they have written which, takenNevertheless, I am inclined to think (though agreeing, so separately from the context, might seem to show that theirfar, with Skoda as to believe that he constantly confounded views and mine are in the main identical; yet, on thethe two conditions) that in the typical cases of pectoriloquy, other hand, there is much in them, and especially in theirto which he originally gave this name, he meant to imply general tenour, which leads me to the opposite conclusion.that he actually heard the patient’s articulate utterances as It seems to me that none of them has, in relation to thiswell as his laryngeal sounds. But he evidently confounded, matter, fully realised the importance of clearly dis-in some way or other, loudness of laryngeal intonation with tinguishing between the sounds evolved at the rima glottidisdistinctness of articulation, and the articulate utterances which are developed in theSkoda affirms that Laennec’s pectoriloquy and broncho- mouth, nose, and fauces. But it is clear that these two

phony represent one and the same phenomenon, and conse- varieties of sound, though blended with one another andquently discards the use of the former word as unnecessary. inseparable as they issue from the lips, are essentially dis-But he divides bronchophony into two varieties, the loud tinct from one another in their seats of development and inand the weak. The loud variety he subdivides into the loud their relations to the cavity of the chest. Sounds producedclear form, "in which," he says, "the thoracic voice may at the rima glottidis are from that very circumstance in abe either as loud as, or louder or somewhat weaker, than the condition not only to be carried outwards with, the ex-laryngeal voice, the articulation being at the same time dis- piratory blast, but to be carried inwards, and it may eventmguishable"; and the loud dull form, "in which the voice be to be increased by resonance in the trachea and its

produces a concussion in the ear, but the articulation, and tributary air-passages. While sounds developed in theconsequently the words spoken, are not recognisable." By mouth are not only, as a rule, of themselves much lessweak bronchophony he does not designate " mere hum- loud and much less musical than laryngeal sounds, brt tming, but a clear and audible voice, which produces little or being developed beyond the larynx, have, in order to reachno concussion in the ear; the articulation of the words the ear applied to the neck or chest, to be carried back-uttered being generally distinctly heard." It will be wards against the breath-stream, and also to pass the barrierobserved, however, that notwithstanding his criticism of of a more or less perfectly closed glottis; and, indeed, itLaennec’s views, he seems incidentally to allow the existence may, I think, be asserted that for the most part theof that very distinction which I repeat that I am inclined to laryngeal sounds accompanying speech are alone carriedthink Laennec intended-namely, that in certain cases of back into the air-passages, and thence to the auscultator’shis bronchophony the articulate words may be recognised, ear. This I regard as bronchophony. There are cases,while in other cases there is only a confused, though possibly however, in which, in addition to laryngeal sounds, articularloud, humming. I suspect that Laennec would have termed utterances are transmitted from the chest-walls to theSkoda’s loud clear bronchophony pectoriloquy ; and that he stethoscope. This is pectoriloquy. Bronchophony, then,would have regarded Skoda’s loud dull bronchophony, and means the conveyance to the ear of sounds developed atweak bronchophony, both ’as bronchophony, notwith- the rima glottidis; pectoriloquy the similar conveyance ofstanding that in the last case the conveyance of the patient’s sounds developed above the rima glottidis. The two con-articulate utterances to the auscultator’s ear is described as ditions appear to me to be quite distinct, and though often,being an essential factor of the phenomenon. possibly in some degree always, united, never to run intoWalshe, in the main, appears to follow Laennec. He one another, in the sense of being different gradations of the

divides bronchophony into simple, pectoriloquous, and same phenomenon.agophonic. As regards bronchophony he says the sound Bronchophony may be either vocal or whispered. In theconveyed to the ear of the listener is ringing and distinct, former variety, which alone is ordinarily understood by thebut unattended with appreciable articulation of the words term, the phenomenon accompanies the natural tones of thespoken. Of pectoriloquous bronchophony he observes that its voice, and, other things being equal, varies in loudness,nature and significance are still sub judice. But he believes, quality, and pitch, according to the strength, quality, andas I do, that Laennec meant by pectoriloquy the specific pitch of the voice ; and also, other things being equal, thepropagation of articulate sounds to the ear ; though I do deeper and stronger the voice the more unpleasant will benot think with Walshe that Laennec ever says so expressly. the vibration which it causes in the ear, and the more dis-And he himself likens it to the voice heard over the larynx, tinct the vocal fremitus which attends it. Whispered bron-and says that it appears to pass directly through the stetho- chophony, taken by itself, is little if anything more thanscope into the observer’s ear, and may throw the concha, expiratory tubular breathing divided into lengths whichand even neighbouring parts of the skull, into more or less correspond to the words the patient utters. What we hear,strong vibration. He continues : " Limited generally to a in fact, with the stethoscope is the unmusical rush of airsmall and accurately defined space, it may have a hollow or through the partially open glottis, on which the patient’sringing character or not. Though as a general fact loud, whispered words are moulded. The sounds uttered dothis is a wholly unessential property of pectoriloquous bron- not correspond accurately in duration to the words them-chophony, depending in great measure on the power of the selves ; for after some letters, and especially after the explo-laryngeal voice ; the hollow and ringing characters, the in- sive consonants, a short supplementary rush occurs, which,sulation of the phenomenon, and its transmission in an though almost inaudible in ordinary conversation, is peculiarlyarticulated form through the stethoscope may be distinctly loud and distinct on auscultation. Whispered bronchophonymarked, even when the speaking voice is almost destroyed. is unattended with the sensible vibration which vocal bron-When the physical conditions of its production exist in a chophony inflicts on the ear and often on the hand. Sincepatient thus reduced almost to a state of aphonia, it becomes speech is always dependent on vocal or whispered lary ngeal

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sound, pectoriloquy cannot be present without bronchophony;but whenever the articulate utterances of the patient can bedistinguished through the stethoscope, there pectoriloquy ispresent. I believe it to be a rare phenomenon; and that mostfrequently where it is supposed to be heard, either the patient’sarticulate sounds reach the auscultator through the air, andblend, unconsciously to him, with the sounds conveyedthrough the stethoscope, or that the inarticulate expiratorygusts of whispered bronchophony are taken for the articulatesounds which the patient utters to dictation, or for thosewhich are given and expected in answer to some leadingquestion. Nevertheless I feel satisfied that it is sometimesmet with, and mainly, if not exclusively, in connexion witlthe whispered voice, in the production of which the glottis iEpartly open, and the conditions best adapted for permittingthe sounds of articulation to enter the trachea are present,I do not propose to discuss the significance and importanceof pectoriloquy and bronchophony. I am inclined, however,to believe that pectoriloquy is heard mainly over cavities.

MENTAL REFLEXES: HABIT.

BY J. MORTIMER-GRANVILLE, M.D.(Concluded from p. 552.)

WE have, thus far, been speaking of mental reflexes v;l i ichfall, so to say, upon natural functions and the automaticcombinations wherefrom normal habits spring. In anotherseries of reflexes, the mind reacts upon the nervous organismin such a fashion as to create new and abnormal com-

binations, thereby instituting habits unknown to health,and which do not fulfil any useful purpose in the economy.The disturbances already noticed changed the orderlyrhythmical acts and processes they influenced, and renderedthem morbid by inhibiting or perverting the automatic

performance of natural functions. In these derangementsnormal combinations were seen to be superseded by ab-normal states of the automatic centres; but in the seriesof phenomena to which we now turn, combinations areformed, and become the bases of habits that must be classedas new, rather than perversions of old and natural, perform-ances. These new habits, springing into existence wherenothing in the nature of habit previously existed, are super-fluous, and in their essential character morbid. Into this

category fall the majority of those involuntary muscularmovements which have no purpose either of act or ex-

pression, and no inconsiderable proportion of the class of thecontortions commonly considered choreic, but which in factare habits, originally incited by some irritant, perhaps anuncomfortable article of dress, or imitated, as in the caseof children, or adults with too weak or plastic minds andgiven to the unconscious reproduction in their own personsof the mannerisms and vagaries of those whom they admireor it may be only respect ; as, for example, the gait andpeculiarities of a public character are often reproduced inthe persons of his immediate friends and followers. Theparticular carriage, deportment, and movements of the imi-tated are unconsciously caught by the imitator. Theseexternal distinguishing marks of the individuality are closelyassociated with habits and tendencies of the mind ; andmoml contagion often spreads by the propagation of, first,bodily, then mental habits. We begin by contracting tricksof the muscular system, observed and imitated, consciouslyor unconsciously; tricks of thought are communicatedthrough, or reproduced by, these movements, associated statesof feeling are set up or transmitted in due sequence, and irprocess of time the two minds are brought into harmonyor the process may be inverted, and mental sympathies an(concords give rise to a similarity of bodily habits. Theris abundant evidence in support of both theories of causation, and it is difficult to say which is the more probabl.explanation of any particular case of resembling, an<

seemingly acquired, personal characteristics. In any eventthe rationale of the development consists in the operationof a reflex. By repetition the acts performed becomhabits, new automatic combinations are created, and th

mannerisms of body and brain pass out of the categorv ofperformances, which may be directly prevented or controlledby the will, and become parts of the system of automaticactions over which the sway of volition is imperfect.

Instances of this morbid production of new combinationsmay be found in nearly all cases of chorea and hysteria.It is the custom to rest satisfied with the reference of thesecharacteristic phenomena to a particular disease, by whichI mean the name, not the state ; but this reference explainsnothing. It throws no light on the nature of the move-ments performed by hysterical and choreic persons to describethem as muscular jactitations produced by erratic or abnormaldischarges of nerve-force, and to adduce in support of this phy-siological hypothesis the familiar fact that if disorderlyaction is restrained in one direction it will break out inanother. The question is-Why are particular movementsperformed, and pretty constantly repeated, when any con-siderable liberation of energy occurs ? The simple fact of aconvulsive or spasmodic movement occurring repeatedly inany part of the muscular system is not sufficient to explainthe similarity of its form in the same subject, on separateoccasions ; still less will it account for that close resemblancewhich is observed between manifestations of the same diseasein different individuals. Nor is it enough to say that thisis "the type " of the malady ; because disease is not an

entity or organism, but simply a state or affection of theorganism in which the morbid action takes place. Neitheris it possible to ascribe the formula of a disease solely to theweakness or tendency of the organism it afl’ects. It is doubt-less true, as often contended, that a morbid or disorderlydischarge of nerve-force will travel in the easiest path, that is,the direction of least resistance; but many of the movementsperformed in disease are difficult and complicated. Thewill could scarcely reproduce them. The only answer to thisquestion I take to be the fact that new automatic combina-tions are set up, either under the excitement of a special irri-tant producing a motor idea, or in obedience to the imitativefaculty, as above alleged. To this it may be objected, withmuch plausibility, that most of the contortions exhibited byidiots and choreic or hysterical persons are, in fact, actionsproper to certain of the lower animals, and therefore pro-bably the result of a disorderly discharge of energy throughdisused but evolutionary centres. This is even true ofmany of the wildest gyrations and muscular vagaries ofpersons afflicted with chorea, in whom the will is ini-

paired, or who are depraved in intellect. The master-piece of creation seems to have been perfected by the ac-

,

cumulation of qualities and properties developed in lower’

organisms. Subordinate instinctive faculties have not beenI superseded in man, but placed under the domination of thewill, restrained and repressed rather than extinguished, so as. to subserve the higher purposes of the supreme organism.When from any cause the will is impaired in its power and

. authority, these lesser properties and qualities assert them-selves unduly and independently. This is why the advancel of paralytic disease is characterised by the display of animalJ or even brutish propensities : thievish and bestial appetites1 and habits proper to the lower animals, but existing in man,, are liberated from restraint, and run riot. In short, underlying,

the intellectual nature of man B’tre the instincts of the organ-isms below him in the scale of development; these are

normally held in subjection by the will, but in the course ofi a disease which either suspends the control of the will by

enfeebling it, or unduly stimulates the automatic svstem of- energies, changes and manifestations take place which seem,3and in a developmental sense are, retrograde. The re-

production of movements resulting from evolutionary com-1 binations is a form of retrogression, and when the tendency, to these automatic acts becomes clearly marked it un-

s doubtedly indicates mental degradation or paralysis. Settingy aside fanciful analogies, it may be noted that the clutching,brushing, scratching, pawing, and catching and prehensiles movements generally, whether performed with the hands orn the mouth, are the most significant of cerebral disease.

: Our immediate concern is, however, with the acquiredmove-d ments which create new combinations. I have onlv alludede to those which wake up pre-existent combinations in order toL- eliminate them from the argument, and dispose of what hase been suggested as a plausible objection to my hypothesis.d In the phenomena characteristic of chorea, hysteria, certaint, forms of epilepsy, and most varieties of nerve and brain dis-n ease, as well as in the class of contortions and convulsiveLe movements which, being slight in themselves and unaecom.le panied by graver symptoms, are loosely described as "tricks

"