In this subject, the first question both logically and chronologically was and is: Can a lesion (focal damage) of the cerebrum cause a loss of language without causing a loss of intelligence? That is the original question, still debated hotly by many people. Much of the heat is attributable to the way in which the question is phrased. Suppose we phrase it relatively, as follows: Can a lesion of the cerebrum produce a deficit in language that is far in excess of the concomitant deficit in intelligence? Asked in this way, almost everyone would answer yes. There are worthy persons who are still arguing that anyone who has a loss of language from a cerebral lesion must have some accompanying loss of intelligence. Similarly, there are equally worthy persons recurrently showing us that intelligence can be preserved in spite of severe aphasia. Both parties are undoubtedly correct. But the force of either argument is largely dissipated when the question is rephrased in the relative way. Of course, how much intelligence is lost (or retained) depends upon how one goes about measuring intelligence; but with almost any measures, except those strictly linguistic, the answer will be yes. Indeed, if the answer were not yes, there would not be such a thing as aphasia, since a "selective loss of language from a cerebral lesion" is what the word "aphasia" means in contemporary usage.Once we all understand that there is such a thing as aphasia, we come to a second question. It is: Can one indicate those places in the cerebrum where an aphasiogenic lesion is likely to occur? Again the answer is yes-an aphasiogenic lesion occurs in right-handed people in the right hemisphere I% of the time, perhaps 2% at most. If you have a person who is definitely right-handed, and he has a cerebral lesion that produces a loss of language far out of proportion to the loss of intelligence, the odds are about 50 to I that the lesion is in the left hemisphere. Indeed, one can localize better than that..It is rather unlikely that the lesion will be in the left occipital pole. It is even less likely that it will be in the left temporal pole and it is very unlikely, although not impossible, that it will be in the left frontal pole. So, in this negative way, we can narrow down to some extent where an aphasiogenic lesion will occur.There is a third question, raised by Wernicke 1 about 1874: Is there more than one kind of aphasia? In other words, when a person suffers linguistic loss with relative preservation of general intelligence, can the linguistic loss be of more than one kind? When we look at the patients, it is obvious that they are different. The question is, should those differences be emphasized, and how? There are almost as many classifications of aphasia as there are aphasiologists. Rephrasing this third question does not seem to help with this argument, which has continued unabated for over a century. In the words of Lhermitte and Gautier: 2 For the present there is no satisfactory classification of aphasias. {page 97)The characterization o...
