Aphasia studied in patients with missile wounds.

Material, Tests, and Records Forty-six convalescent cases of penetrating missile wounds of the dominant hemisphere, having some relevant symptoms, were selected at the Military Hospital for Head Injuries, Oxford, and subjected to various tests. Two were left-handed, with wounds of the right hemisphere, and two others had multiple brain injuries. One was practically illiterate, probably owing to a congenital defect which left his general intelligence fairly intact. Each patient was given a short explanation and then his response to questions about his speech trouble was taken down verbatim. This was followed by the spontaneous naming byfree association of a maximum number of animals in one minute, and a vocabulary test. These tests allowed estimation of the disturbance of articulation, inflection, and speed, of the tendency to paraphasia, jargon, and syntactical errors, and of the difficulty in finding words for ideas. The patient's responses to the first sixteen words of the StandfordBinet vocabulary test were recorded verbatim, and found to be useful as a direct, if somewhat formal means of estimating his expressive power. Eight words were given orally, then the patient was asked to read and explain the remaining eight. Next, ten coloured pictures of simple objects were exposed to be named. The patient was then asked to point to that picturedobject which was named by the examiner, and finally to the one the name of which was printed on a slip. This was an easy test for naming, and for the understanding of written and spoken words. Understanding was further tested by the patient's ability to execute simple commands with regard to his body, the most difficult involving three different actions to be done synchronously. Reading monosyllables (three-letter words) with a time limit of one minute was another check on speed and ability to convert visual symbols into those of sound. Reading 18 of seven figures from one to four digits, and eventually a twenty-word sentence including three or four rather difficult words, completed the evaluation of this aspect of speech. The writing tests were graduated from a dictation of ten words, consisting of one to ten letters, to the figures and the sentence previously read. From this the ability to spell was computed. If the patient failed in this test he was asked to copy ten single letters, seven figures, and the twenty-word sentence. If the disturbance was not gross, the simplest tests were sometimes omitted. In the end the patients were asked to copy the StanfordBinet shapes from the mental age tests (form M) for nine and twelve years, and to perform the first five patterns of the Kohs' blocks test, in order to estimate visual and constructive ability. Finally they were given the serial seven test, and usually an abbreviated (halved) form of Raven's Matrices to test calculation and abstract thinking. At some stage of the session a neurological examination was made. The following (Case 1) is an example of the verbatim responses to direct questions and the vocabulary test. 'The patient, a trooper aged 22, had been a storekeeper and before his injury was fairly talkative. He was right-handed. Six months before his examination he had suffered severe concussion. (What is the matter with your speech ?.. . t Hm. To say names. (Is it that you can't remember them ?) No-really. Hm. Sometimes yes; but Ihave no idea how the noise-no ... (Do you mean the sound ?) Yes, sound is foun-is formed. (Can you understand what is being said to you ?) Oh yes, (How about reading?) Out loud ? (Can you read to yourself?) Yes. (Are you slow, when you are reading to yourself?) (Slower than you used to be ?) Yes, but not,so much. (Hcw is your writing?) Writing I have to think of every word. I-it-takes-mne-about one hour to do-a-write-a-pace-page-page.