Chapter III: The Resonator and Articulator (2)

CASE OF DEAFNESS ARISING FROM DESTRUCTION OF THE AUDITORY CENTRES IN THE BRAIN CAUSING LOSS OF SPEECH

A woman at the age of twenty suddenly became unconscious and remained so for three hours; on recovery of consciousness it was found she could not speak; this condition remained for a fortnight; speech gradually returned, although it was impaired for a month or more. She married, but soon after marriage she suddenly lost her hearing completely, remaining permanently stone deaf; and although she could understand anything of a simple character when written, and was able imperfectly to copy sentences, she was unable to speak. Once, however, under great emotional excitement, while I was examining her by written questions, she uttered, "Is that." But she was never heard to speak again during the subsequent five years that she lived. The utterance of those two words, however, showed that the loss of speech was not due to a defect of the physiological mechanism of the vocal instrument of speech, nor to the motor centres in the brain that preside over its movements in the production of articulate speech. She recognised pictures and expressed satisfaction or dissatisfaction when correct or incorrect names were written beneath the pictures; moreover, in many ways, by gestures, facial expression, and curious noises of a high-pitched, musical, whining character, showed that she was not markedly deficient in intelligence. Although in an asylum and partially paralysed, she was not really insane in the proper sense, but incapable of taking care of herself. When other patients were getting into mischief this patient would give a warning to the attendants by the utterance of inarticulate sounds, showing that she was able to comprehend what was taking place around and reason thereon, indicating thereby that although stone deaf and dumb, it was probable that she possessed the power of silent thought. I observed that during emotional excitement the pitch of the sounds she uttered increased markedly with the increase of excitement. After having been discharged from Claybury Asylum she was sent to Colney Hatch Asylum. Upon one of my visits to that institution I learnt that she had been admitted, and upon my entering the ward, although more than a year had elapsed since I last saw her, she immediately and from afar recognised me; and by facial expression, gesture, and the utterance of inarticulate sounds showed her great pleasure and satisfaction in seeing one who had taken a great interest in her case. This poor woman must have felt some satisfaction in knowing that someone had interpreted her mental condition, for of course, her husband and friends did not understand why she could not speak. I may mention that the first attack of loss of speech was attributed to hysteria.

This woman died of tuberculosis seven years after the second attack, and examination of the brain _post-mortem_ revealed the cause of the deafness. There was destruction of the centre of hearing in both hemispheres (_vide_ fig. 17), caused by blocking of an artery supplying in each hemisphere that particular region with blood. The cause of the blocking of the two arteries was discovered, for little warty vegetations were found on the mitral valve of the left side of the heart. I interpreted the two attacks thus: one of these warty vegetations had become detached, and escaping into the arterial circulation, entered the left carotid artery and eventually stuck in the posterior branch of the middle cerebral artery, causing a temporary loss of word memory, consequently a disturbance of the whole speech zone of the left hemisphere. This would account for the deafness to spoken language and loss of speech for a fortnight, with impairment for more than a month, following the first attack. But both ears are represented in each half of the brain; that is to say, sound vibrations entering either ear, although they produce vibrations only in one auditory nerve, nevertheless proceed subsequently to both auditory centres. The path most open, however, for transmission is to the opposite hemisphere; thus the right hemisphere receives most vibrations from the left ear and _vice versa_. Consequently the auditory centre in the right hemisphere was able very soon to take on the function of associating verbal sounds with the sense of movement of articulate speech and recovery took place. _But_, when by a second attack the corresponding vessel of the opposite half of the brain was blocked the terminal avenues, and the central stations for the reception of the particular modes of motion associated with sound vibration of all kinds were destroyed _in toto_; and the patient became stone deaf. It would have been extremely interesting to have seen whether, having lost that portion of the brain which constitutes the primary incitation of speech, this patient could have been taught lip language.

There is no doubt that persons who become deaf from destruction of the peripheral sense organ late in life do not lose the power of speech, and children who are stone deaf from ear disease and dumb in consequence can be trained to learn to speak by watching and imitating the movements of articulation. Helen Keller indeed, although blind, was able to learn to speak by the education of the tactile motor sense. By placing the hand on the vocal instrument she appreciated by the tactile motor sense the movements associated with phonation and articulation. The tactile motor sense by education replaced in her the auditory and visual senses. The following physiological experiment throws light on this subject. A dog that had been deprived of sight by removal of the eyes when it was a puppy found its way about as well as a normal dog; but an animal made blind by removal of the occipital lobes of the brain was quite stupid and had great difficulty in finding its way about. Helen Keller's brain, as shown by her accomplishments in later life, was a remarkable one; not long after birth she became deaf and blind, consequently there was practically only one avenue of intelligence left open for the education of that brain, viz. the tactile kinæsthetic. But the tactile motor sense is the active sense that waits upon and contributes to every other sense. The hand is the instrument of the mind and the agent of the will; consequently the tactile motor sense is intimately associated in its structural representation in the brain with every other sense. This avenue being open in Helen Keller, was used by her teacher to the greatest possible advantage, and all the innate potentialities of a brain naturally endowed with remarkable intellectual powers were fully developed, and those cortical structures which normally serve as the terminal stations (_vide_ fig. 16) for the reception and analysis of light and sound vibrations were utilised to the full by Helen Keller by means of association tracts connecting them with the tactile motor central stations. The brain acts as a whole in even the simplest mental processes by virtue of the fact that the so-called functional centres in the brain are not isolated fields of consciousness, but are inextricably associated one with another by association fibres.

THE PRIMARY REVIVAL OF SOME SENSATIONS IN THE BRAIN

I have on page 77 referred to Stricker's views on the primary revival of words in the sense of movement of the lips and tongue. Mach ("Analysis of the Sensations") says: "The supposition that the processes in the larynx during singing have had something to do with the formation of the tonal series I noticed in one of my earlier publications, but did not find it tenable. Singing is connected in too extrinsic and accidental a manner with hearing to bear out such an hypothesis. I can hear and imagine tones far beyond the range of my own voice. In listening to an orchestral performance with all the parts, or in having an hallucination of such a performance, it is impossible for me to think that my understanding of this broad and complicated sound-fabric has been effected by my _one_ larynx, which is, moreover, no very practised singer. I consider the sensations which in listening to singing are doubtless occasionally noticed in the larynx a matter of subsidiary importance, like the pictures of the keys touched which when I was more in practice sprang up immediately into my imagination on hearing a performance on the piano or organ. When I imagine music, I always distinctly hear the notes. Music can no more come into being merely through the motor sensations accompanying musical performances, than a deaf man can hear by watching the movements of players. I cannot therefore agree with Stricker on this point" (comp. Stricker, "Du langage et de la musique," Paris, 1885).

Of the motor type myself and having a fairly good untrained ear for music, I find that to memorise a melody, whether played by an instrument or by an orchestra, I must either try to sing or hum that melody in order to fix it in my memory. Every time I do this, association processes are being set up in the brain between the auditory centres and the centres of phonation; and when I try to revive in my silent thoughts the melody again, I do so best by humming aloud a few bars of the melody to start the revival and then continuing the revival by maintaining the resonator in the position of humming the tune, viz. with closed lips, so that the sound waves can only escape through the nose; under such circumstances the only definite conscious muscular sensation I have is from the effect of closure of the lips; the sensations from the larynx are either non-existent or quite ill-defined, although I hear mentally the tonal sensations of the melody. No doubt by closing the lips in silent humming I am in some way concentrating attention to the sensori-motor sphere of phonation and articulation, and by reactive association with the auditory sphere reinforcing the tonal sensations in the mind. The vocal cords (ligaments) themselves contain very few nerve fibres; those that are seen in the deeper structures of the cords and adjacent parts mainly proceed to the mucous glands. This fact, which I have ascertained by numerous careful examinations, is in accordance with the fact that there are no conscious kinæsthetic impressions of alterations of position and tension of the vocal cords. A comparative microscopic examination of the tip of the tongue and the lips shows a remarkable difference, for these structures are beset with innumerable sensory nerves, whereby every slightest alteration of tension and minute variations in degrees of pressure of the covering skin is associated with messages thereon to the brain. The sense of movement in articulate speech is therefore explained by this fact. There is every reason then to believe that auditory tonal images are the sole primary and essential guides to the minute alterations of tension in the muscles of the larynx necessary for the production of corresponding vocal sounds. By humming a tune we concentrate our attention and thereby limit the activity of neural processes to systems and communities of neurones employed for the perception of tonal images and their activation in motor processes; and this helps to fix the tune in the memory.

PSYCHIC MECHANISM OF THE VOICE

A musical speaking voice denotes generally a good singing voice, and it must be remembered that articulation cannot be separated from phonation in the psychic mechanism. In speaking, we are unconscious of the breath necessary for the production of the voice. Not so, however, in effective singing, the management of the breathing being of fundamental importance; and it is no exaggeration to say that only the individual who knows how to breathe knows how to sing effectually. A musical ear and sense of rhythm are innate in some individuals; in others they are not innate and can only be acquired to a variable degree of perfection by persevering efforts and practice. The most intelligent persons may never be able to sing in tune, or even time; the latter (sense of rhythm) is much more easily acquired by practice than the former (correct intonation). This is easily intelligible, for rhythmical movement appertains also to speech and other acts of human beings, e.g. walking, dancing, running, swimming, etc.; moreover, rhythmical periodicity characterises the beat of the heart and respiration.

But how does a trained singer learn to sing a song or to take part in an opera? He has to study the performances of two parts for the vocal instrument--the part written by the composer and the part written by the poet or dramatist--and in order to present an artistic rendering, the intellectual and emotional characters of each part must be blended in harmonious combination. A singer will first read the words and understand their meaning, then memorise them, so that the whole attention subsequently may be given to applying the musical part to them and employing with proper phrasing, which means more than knowing when to breathe; it means imparting expression and feeling. A clever actor or orator can, if he possess a high degree of intelligence and a fairly artistic temperament, so modulate his voice as to convey to his audience the passions and emotions while feeling none of them himself; so many great singers who are possessed of a good musical ear, a good memory, and natural intelligence, although lacking in supreme artistic temperament and conspicuous musical ability, are nevertheless able to interpret by intonation and articulation the passions and emotions which the composer has expressed in his music and the poet or dramatist in his words. The intelligent artist possessed of the musical ear, the sense of rhythm, and a well-formed vocal organ accomplishes this by the conscious control and management of his breathing muscles and the muscles of articulation, which by education and imitation he has brought under complete control of the will. With him visual symbols of musical notes are associated with the visual symbols of words in the mind, and the visual symbols whether of the words or of the musical notes will serve to revive in memory the sound of the one or the other, or of both. But he produces that sound by alteration of tension in co-ordinated groups of muscles necessary for vocalisation, viz. the muscles of phonation in the larynx, the muscles of articulation in the tongue, lips, jaw, and palate, and the muscles of costal respiration. _The mind_ of the orator, actor, and dramatic singer exercises a profound influence upon the respiratory system of nerves, and thereby produces the necessary variations in the force, continuance, and volume of air required for vocal expression.

Sir Charles Bell, who discovered the respiratory system of nerves, pointed out how the lungs, from being in the lower animals merely the means of oxygenating the blood, become utilised in the act of expelling air from the body for the production of audible sounds--the elements of human voice and speech. Likewise he drew attention to the influence which powerful emotions exercise upon the organ of respiration, including the countenance, e.g. the dilated nostrils in anger. Again, "when the voice suffers interruption and falters, and the face, neck, and chest are animated by strong passion working from within the breast, language exerts its most commanding influence."

In hemiplegia or paralysis of one half of the body, there is a difference between the two sides for ordinary automatic unconscious diaphragmatic breathing and voluntary or costal breathing. Thus in ordinary breathing the movements are increased on the paralysed side, especially in the upper part of the chest, while in voluntary breathing they are increased on the sound side. Hughlings Jackson suggested the following theory to explain these facts: "_Ordinary breathing_ is an automatic act governed by the respiratory centre in the medulla. The respiratory centre is double, each side being controlled or inhibited by higher centres on the opposite side of the brain. Voluntary costal breathing, such as is employed in singing, is of cerebral origin, and controlled by centres on the opposite side of the brain, the impulses being sent down to the respective centres for the associated movements of the muscles of articulation, phonation, and breathing, in the same way as they are sent to the centres for the movements of the arm or leg. With voluntary breathing the respiratory centre in the medulla has nothing to do. It is in fact out of gear or inhibited for the time being, so that the impulses from the brain pass by or evade it. There are thus two sets of respiratory nerve fibres passing from the brain--the one inhibiting or controlling to the opposite half of the respiratory centre in the medulla; the other direct, evading the respiratory centre and running the same course to the spinal centres for the respiratory movements as the ordinary motor fibres do to the centres for other movements. Both sets would be affected by the lesion (or damage) which produced the hemiplegia. The inhibitory fibres being damaged, the opposite half of the respiratory centre would be under diminished control and therefore the movements of ordinary breathing on the paralysed side would be exaggerated. The damage to the direct fibres would prevent the passage of voluntary stimuli to the groups of respiratory muscles (as it would do to the rest of the muscles of the paralysed side), and thus the voluntary movement of respiration would be diminished--diminished only and not completely abolished as in the limbs; because according to the theory of Broadbent, in the case of such closely associated bilateral movements the lower nervous respiratory centres of both sides would be activated from either side of the brain." This certainly applies also to the muscles of phonation, but not to the principal muscles of articulation, viz. the tongue and lips. It is not exactly known what part of the cerebral cortex controls the associated movements necessary for voluntary costal (rib) respiration in singing; probably it is localised in the frontal lobe in front of that part, stimulation of which gives rise to trunk movements (_vide_ fig. 16). Whatever its situation, it must be connected by association fibres with the centres of phonation and articulation.

[Description: FIG. 18.--The accompanying diagram is an attempt to explain the course of innervation currents in phonation.

1. Represents the whole brain sending voluntary impulses _V_ to the regions of the brain presiding over the mechanisms of voluntary breathing and phonation. These two regions are associated in their action by fibres of association _A_; moreover, the corresponding centres in the two halves of the brain are unified in their action by association fibres _A'_ in the great bridge connecting the two hemispheres (Corpus Callosum). On each side of the centre for phonation are represented association fibres _H_ which come from the centre of hearing; these fibres convey the guiding mental images of sounds and determine exactly the liberation of innervation currents from the centre of phonation to the lower centres by which the required alterations in tension of the laryngeal muscles for the production of the corresponding sounds are effected. Arrows are represented passing from the centre of phonation to the lower centres in the medulla which preside over the muscles of the jaw, tongue, lips, and larynx. Arrows indicate also the passage of innervation currents from the centres in the brain which preside over voluntary breathing. It will be observed that the innervation currents which proceed from the brain pass over to the opposite side of the spinal cord and are not represented as coming into relation with the respiratory centre _R_. This centre, as we have seen, acts automatically, and exercises especially its influence upon the diaphragm, which is less under the control of the will than the elevators of the ribs and the abdominal muscles.

The diagram also indicates why these actions of voluntary breathing and phonation can be initiated in either hemisphere; it is because they are always bilaterally associated in their action; consequently both the higher centres in the brain and the lower centres in the medulla oblongata and spinal cord are united by bridges of association fibres, the result being that even if there is a destruction of the brain at _a-b_, still the mind and will can act through both centres, although not so efficiently. Likewise, if there is a destruction of the fibres proceeding from the brain centres to the lower medullary and spinal centres, the will is still able to act upon the muscles of phonation and breathing of both sides of the body because of the intimate connection of the lower medullary and spinal centres by association fibres.]

Experiments on animals and observations on human beings show that the centres presiding over the muscles of the larynx are situated one in each hemisphere, at the lower end of the ascending frontal convolution in close association with that of the tongue, lips, and jaw. This is as we should expect, for they form a part of the whole cerebral mechanism which presides over the voice in speech and song. But because the muscles of the tongue, the lower face muscles, and even the muscles of the jaw do not necessarily and always work synchronously and similarly on the two sides, there is more independence in their representation in the cerebral cortex. Consequently a destruction of this region of the brain or the fibres which proceed from it to the lower executive bulbar and spinal centres is followed by paralysis of the muscles of the opposite side. Likewise stimulation with an interrupted electric current applied to this region of the brain in monkeys by suitable electrodes produces movements of the muscles of the lips, tongue, and jaw of the opposite side only. Not so, however, stimulation of the region which presides over the movements of the muscles of the larynx, for then _both_ vocal cords are drawn together and made tense as in phonation. It is therefore not surprising if removal or destruction of this portion of the brain _on one side_ does not produce paralysis of the muscles of phonation, which, always bilaterally associated in their actions, are represented as a bilateral group in both halves of the brain. These centres may be regarded as a part of the physiological mechanism, but the brain acts as a whole in the psychic mechanism of speech and song. From these facts it appears that there is: (1) An automatic mechanism for respiration and elemental phonation (the cry) in the medulla oblongata which can act independently of the higher centres in the brain and even without them (_vide_ p. 18). (2) A cerebral conscious voluntary mechanism which controls phonation either alone or associated with articulation. The opening of the glottis by contraction of the abductor (posterior ring-pyramid muscles) is especially associated with descent of the diaphragm in inspiration in ordinary breathing; whereas the voluntary breathing in singing is associated with contraction of the adductor and tensor muscles of the vocal cords.

A perfect psychic mechanism is as necessary as the physiological mechanism for the production of perfect vocalisation, especially for dramatic singing. A person, on the one hand, may be endowed with a grand vocal organ, but be a failure as a singer on account of incorrect intonation, of uncertain rhythm or imperfect diction; on the other hand, a person only endowed with a comparatively poor vocal instrument, but knowing how to use it to the best advantage, is able to charm his audience; incapable of vigorous sound production, he makes up for lack of power by correct phrasing and emotional expression. We see then that the combination of a perfect physiological and psychological mechanism is essential for successful dramatic singing, the chief attributes of which are: (1) Control of the breath, adequate volume, sustaining power, equality in the force of expulsion of air to avoid an unpleasant vibrato, and capability of producing and sustaining loud or soft tones throughout the register. (2) Compass or range of voice of not less than two octaves with adequate control by mental perception of the sounds of the necessary variation in tension of the laryngeal muscles for correct intonation. (3) Rich quality or timbre, due partly to the construction of the resonator, but in great measure to its proper use under the control of the will. Something is lacking in a performance, however perfect the vocalisation as regards intonation and quality, if it fails to arouse enthusiasm or to stir up the feelings of an audience by the expression of passion or sentiment through the mentality of the singer.

The general public are becoming educated in music and are beginning to realise that shouting two or three high-pitched chest notes does not constitute dramatic singing--"a short _beau moment_ does not compensate for a _mauvais quart d'heure_." It would be hard to describe or define the qualities that make a voice appeal to the multitude. Different singers with a similar timbre of voice and register may sing the same song correctly in time, rhythm, and phrasing, and yet only one of them may produce that sympathetic quality necessary to awaken not only the intellectual but the affective side of the mind of the hearers. Undoubtedly the effects produced upon the mind by dramatic song largely depend upon circumstances and surroundings, also upon the association of ideas. Thus I was never more stirred emotionally by the human voice than upon hearing a mad Frenchman sing at my request the Marseillaise. Previously, when talking to him his eyes had lacked lustre and his physiognomy was expressionless; but when this broad-chested, six foot, burly, black-bearded maniac rolled out in a magnificent full-chested baritone voice the song that has stirred the emotions and passions of millions to their deepest depth, and aroused in some hope, in others despair, as he made the building ring with "Aux armes, citoyens, formez vos bataillons" I felt an emotional thrill down the spine and a gulp in the throat, while the heart and respirations for an instant stayed in their rhythmical course. Not only was I stirred by the effect of the sounds heard, but by the change in the personality of the singer. It awakened in my mind the scenes in the French Revolution so vividly described by Carlyle. The man's facial expression and whole personality suddenly appeared changed; he planted his foot firmly forward on the ground, striking the attitude of a man carrying a musket, a flag, or a pike; his eyes gleamed with fire and the lack-lustre expression had changed to one of delirious excitement. A pike in his hand and a red cap on his head would have completed the picture of a _sans culotte_. Dramatic song therefore that does not evoke an emotional response is _vox et præterea nihil_.

INDEX

A

Abductors and Adductors of Vocal cords, 30 _seq._ Aikin, Dr., 33, 45, 46, 47 Classification of Consonants, 54 "The Voice," 44 Aphasia, Motor and Sensory, 72 _seq_. Articulation and phonation, 57 _seq_., 92, 94 _seq_., fig. 18 Assyria, clay records, 70

B

Ballet, 78 Bastian, Dr., 72, 78 Beethoven, symphonies, 40 Bell, Sir Charles, 97 Bouillaud, M., 68 Brain:-- How developed, 10 Localisation of Speech Centres, 72 _seq_., fig. 17 Primary Revival of Sensations, 90 Primary Site of Revival of words in Silent thought, 80 _seq._ Relation to the Voice, 61 _et passim_ Structure, 63 _seq_., figs. 15, 16, 17 Breathing, art of, 16 _seq_., 22, 26, 27, 94 _seq._ Broadbent, Sir W., 99 Broca, 72, 76

C

Charcot, 78 Consonants, 50 _seq._ Classifications, 54 Cunningham, Professor, 71

D

Darwin, 83 "Expression of the Emotions," 3 Dax, Marc, 69 Deaf Mutes, 62, 71, 82 Deafness causing loss of speech, 84 _seq._ Diaphragm, 20 _seq_., 103, fig. 2

E

Ear in Music, 39 English, difficult to sing, 55 Epiglottis, 28, 31

F

Flame Manometer, 48, fig. 14 French, Dr., 32, 37

G

Gall, founder of Phrenology, 67, 68 Galton, 78, 79 Garcia, 34 Gibbon, the, 3 Glottis, 30, 35, 44, 103, fig. 10 Goltz's dog, 18 Gowers, on Bulbar Paralysis, 57 Grieger, 5

H

Harmonics, 14, 47 _seq_. Hearing and Speech, 78, 82 _seq_. Helmholtz, 45, 47, 48, 50, 55 Hermann, on Articulate Sounds, 50 Groups of Consonants, 54 Huxley, 8

I

Italian, easy to sing, 55

J

Jackson, Hughlings, 97

K

Keller, Helen, 40, 89, 90 Kingsley, Miss, 6 Klang, 13 König, flame manometer, 48, fig. 14

L

Language, a human attribute, 61 Of Gesture, 6, 7, 71 Written, 8 Laryngoscope, 34, 35, 37, fig. 9 Larynx, 28 _seq_., figs. 4-8

M

Macaulay, Lord, 79 Mach, "Analysis of Sensations," 79, 90 Marie, M., 73, 76 Marseillaise, 106 Memory, visual, 79, 80 Mouth, 43, 44 Müller, Max, "Chips from a German Workshop," 8

N

Nerves of Respiration, 21 Neurologists, 73

O

Overtones, 14, 47 _seq_.

P

Paget, Sir James, 79 Paralysis:-- Bulbar, 57 Hemiplegia, 97 Of the Insane, 58 Paris Academy of Science, 68 Parrot, Speech, 60 Phonation and Articulation, 57 _seq_., 92, 94 _seq._., fig. 18 Phrenology, 67, 68 Pitch, 34, 36, 37, 39, 46, 50, 55

R

Reading and Thinking by Articulating Words, 77 Resonator, 15 _seq_., 41 _seq_. Rhythmical Movement, 94 Ribot, 79 On Words, 5 Right-handedness and Speech, 69 _seq_., 80 Rodents, 3 Romanes, "Mental Evolution in Man," 1, 3, 83

S

Sayce, 6
Semon, Sir Felix, 32, 37
Singing, 95, 98 _seq_.
Chief Attributes, 104 _seq_.
Hearing and, 91
Sound-pipe, 33
Sounds, articulate, 50 _seq_., 60 _seq_.
Sounds, musical, three qualities, 11 _seq._
Speech:--
Cerebral Mechanism of song and, 60 _seq._
Defects, 57 _seq_., 73
Hearing and, 78, 82 _seq_.
Localisation centres in the brain, 72 _seq_., fig. 17
Loss of, caused by deafness, 84 _seq_.
Right-handedness, 69 _seq_., 80
Theories on the origin of, 1 _seq._
Three stages, 4
Spencer, Herbert, 76
Stricker, 77, 78, 80, 82, 90

T

Thorax, 18 _seq_., fig. 3 Throat, 43 Timbre, 13 Tuning-forks, 12, 13, 37 Tylor, 6

V

Ventricle, 33 Vocal cords, 29 _seq_., 35, 36, 37, 43, 93, figs. 10, 11 Vocal instrument, three parts 15 _seq_., 62 _et passim_ Bellows, 18 _seq_., fig. 1 Reed, 28 _seq_., _See also_ Larynx Resonator, 41 _seq_. Vocal Muscle, 31 Vocalisation. _See_ Singing Voice, compass of, 34, 37 Voice, psychic mechanism, 94 _seq_.

W

Wernicke's sensory aphasia, 84 Word-memory, 78 Words, defined, 82