Similar to apraxia is "aphasia" or loss of ability to speak. It bears the same relation to true paralysis of the speech organs that hand apraxia bears to paralysis of the hand. Through brain injury it sometimes happens that a person loses his ability to speak words, though he can still make vocal sounds. The cases differ in severity, some retaining the ability to speak only one or two words which {58} from frequent use have become almost reflex (swear words, sometimes, or "yes" and "no"), while others are able to pronounce single words, but can no longer put them together fluently into the customary form of phrases and sentences, and still others can utter simple sentences, but not any connected speech.

Fig. 16.--Side view of the left hemisphere, showing the location of the "speech centers." The region marked "Motor" is the motor speech center, that marked "Auditory" the auditory speech center, and that marked "Visual" the visual speech center. (Figure text: central fissure, motor area, auditory area, visual area, fissure of Sylvius, brain stem, cerebellum)

In pure cases of motor aphasia, the subject knows the words he wishes to say, but cannot get them out. The brain injury here lies in the frontal lobe in the left hemisphere, in right-handed people, just forward of the motor area for the mouth, tongue and larynx. This "motor speech center" is the best-known instance of a super-motor center. It coÖrdinates the elementary speech movements into the combinations called words; and perhaps there is no other motor performance so highly skilled as this of speaking. It is acquired so early in life, and practised so constantly, that {59} we take it quite as a matter of course, and think of a word as a simple and single movement, while in fact even a short word, as spoken, is a complex movement requiring great motor skill.

There is some evidence that the motor speech center extends well forward into the frontal lobe, and that the front part of it is related to the part further back as this is to the motor area back of it. That is to say, the back of the speech center combines the motor units of the motor area into the skilled movements of speaking a word, while the more forward part of the speech center combines the word movements into the still more complex movement of speaking a sentence. It is even possible that the very front part of the speech center has to do with those still higher combinations of speech movements that give fluency and real excellence of speaking.