From the Archives.

Paraphrasing the context from Sir William Gowers, Dr Alajouanine (Fig. 1) declares his subject as lying within the ‘borderlands of aphasia’—specifically the effects of aphasia on three individuals, known to him professionally, each having considerable pre-morbid artistic ability in writing, music or painting, respectively. He considers whether comparisons of their work before and after the onset of illness might illuminate the psychology of language, the mental state associations of aphasia, or (what we would now call) the ‘neuroscience’ of artistry. The successful writer makes his conversational language prosy and tunes his prose to reflect everyday language. He writes as he speaks and vice versa, mimicking Moliere’s ‘Would-be gentleman’, M. Jourdain, who was amazed and delighted ‘that his language was prose and that he was thus using prose without being aware of it’. For Charles Baudelaire, ‘perhaps . . . the greatest French poet of the 19th century . . . [who] suffered from [sudden] right-sided hemiplegia with aphasia . . . [being] able to say just one word, a curse: ‘‘cré-nom’’ . . . to express quite different states of mind . . . the essential features so well expressed by Hughlings Jackson: the preservation of a ‘‘leit-motiv word’’ (a curse as so frequently is the case)’, aphasia closed the door on artistic expression. And like Baudelaire, for whom ‘one fact is sure: any artistic realisation had been since forbidden’, the aphasic writer, musician or painter may become artistically mute. Dr Alajouanine’s contemporary French writer—still living and so anonymous—became acutely aphasic and hemiplegic at the height of his powers as a poet, novelist and literary critic specialising in the English canon. Expressive aphasia with reasonable preservation of comprehension gradually improved through stages of ‘leit-motiv’ in which output was initially confined to the stereotyped utterance of ‘Bonsoir les choses d’ici bas’, and later a state of reasonable vocabulary, phonetics and adequate syntactical construction both in speech and writing. But whereas this author remained able to read and appreciate the nuances of literature in several languages, all creativity was rendered impossible through the loss of synthetic construction—‘at least the one he was used to for he did not employ that conventional agrammatism of some of the young literary schools’. This failure of artistic output cannot be attributed to loss of memory, reasoning, judgement or affect. For example – having indicated his views on James Joyce but finding himself stuck for the name of another English-language author on whom he had also written a critique—the writer easily picks out a book from his shelves written by the un-nameable Englishman (the 19th century poet, Coventry Patmore). The patient can proofread and see through to publication works in press. And he is able judiciously to improve a piece in production that both he and his editor agree is inferior in places by indicating where the problems lie. Nor are his aesthetic sensibilities impaired. The essence of his disability is a ‘disease which converted that delicate artist and subtle grammarian into an agrammatist’. Turning to his second case, Dr Alajouanine explains how, just as aphasia breaks the ‘poet’s calamus’ so, too, it ‘ruins Orpheus’s lyre’ and reduces the musician’s ability to vary the laws of harmony, instrumental technique and rich orchestral possibility into the language of music. The patient is Maurice Ravel. He had ‘introduced a novel style, an original manner . . . expressed in a particular language . . .which will endure in the history of his art’. Ravel considered himself to ‘think and feel in sounds . . .. I am a musical hydrant, music flows from me like water’. Gradually, he develops Wernicke’s aphasia with ideomotor apraxia. The cause is a form of cerebral atrophy but not Pick’s disease. Memory, judgement, affect and aesthetic sense are unimpaired; spoken language is moderately affected and writing much impaired by apraxia. Musical expression is lost but musical thinking retained. A favoured pupil and a neurologist talented in music have analysed Ravel’s difficulties: he can recognise his own and other composers’ tunes and detect errors (when his pupil inserted mistakes of notation or rhythm in a rendering of the ‘Tombeau de Couperin’, started in 1914 and completed in 1917 with each movement dedicated to a friend killed in battle, or ‘La Pavanne de ma Mère l’Oye’); register that Dr Alajouanine’s piano needs tuning; and listen to, enjoy and make critical comments upon performances. Conversely, he cannot name or decipher notes or write musical notation. He can play with the right hand but not both together except for a few snatches of pieces known by heart, especially his own—an irony since Ravel had written a piano concerto for the left hand in 1931 (commissioned by Paul Wittgenstein, an Austrian pianist who lost his right arm in the Great War, and considered by Max Harrison [Phillips Classics Productions 1993] to be a work of subversive violence and black magic); and he can also sing familiar pieces. Together, these disabilities explain why doi:10.1093/brain/awm309 Brain (2008), 131, 3^5