Blast from the past – Mills (1904). Treatment of aphasia by training

"Whisky": Highly familiar and easily recogniseable

“In testing him for powers of word-seeing, letter-seeing and number-seeing, it was evident that he recognised some letters and some words much better than others. This was especially true with regard to words.He could always pick out words which had evidently been unusually familiar to him before his seizure; for example, the words whisky, brandy and beer in the hospital diet list were at once recognised, although most other words he could not tell, except in a few cases with difficulty”

A look at: Mills, C. K. (1904). Treatment of aphasia by training. Journal of the American Medical Association, 43, 1940-1949.

So I was browsing around the web trying to find a reference for a nice review article or some such on phonological therapy outcomes for people with aphasia when i came across a really nice resource from the University of Arizona presenting Aphasia Treatment Evidence Tables. As I browsed through some of the tables my eyes were drawn to this reference from 1904. Obviously this is not the earliest account of aphasia, as the likes of Paul Broca, Carl Wernicke, and Sigmund Freud  were documenting and detailing accounts during the 1800s. However, it was the earliest in these particular tables with the second earliest study being from 1959.This therefore presented a bit of a curiosity to me and I thought I’d try to track it down, which was in fact pretty straight forward as my library had it in stock (even if hidden away somewhere in the basement).

Mills (1904) essentially presents a series of accounts, either first hand or recounted through correspondence, and reflections on treatments for people with aphasia that he and others had administered.Through this he also distills a number of principles, or examples, of treatment exercises.

What is quite striking is the clarity of the writing and the vividness of the descriptions which really allows the modern-day speech and language therapist/pathologist to get a clear picture of the difficulties that the particular patients faced.This was naturally written before the time of cognitive neuropsychological models of language processing (inputs, outputs, buffers and all that) but the depth of description is so immediately transparent that the modern-day clinician can have a fairly good stab at hypothesising what levels of processing have been impaired:

The patient fell in an apoplectiform attack, and was taken to one of the London hospitals, where he was seen by Dr. Sieveking and Dr. Broadbent.He was a right hemiplegic and was also totally aphasic and agraphic, but appeared not to have been word deaf, as he understood what was said to him.He had lost all ideas of numbers, but was evidently not word blind, as he understood from the first what he saw in print or in script.When he read aloud he had a marked form of paraphasia, his speech being of the jargon or gibberish type.Like many such patients, he read off this jargon as if to himself he were reading correctly.He could copy, although unable to write spontaneously” (p1940)

There are also a number of interesting questions raised which are still relevant today, including the efficacy of treating speech disorders by asking patients to repeat monosyllables (e.g. ‘ut, re, mi’).Mills points out that while a Dr Goldscheider thought this was a good idea, a Dr Burr disagreed and instead considered it “much better to educate them [patients] in sounds that mean something – boy, bell, book, and so on” (p1948)- clearly still relevant in terms of current practices of oro-motor exercises in impairments to motor programming (i.e. apraxia of speech).

There are speculations on whether treatment prompts reactivation or reorganisation of neural matter:

There is no doubt but that the zone affected is becoming smaller and smaller, or else that the right side of the brain is being educated to take the place to some extent of that part affected on the left.As, of course, you will readily appreciate, it is extremely difficult for me to know whether it is really a smaller portion of the zone affected which enables him to show these signs of improvement or whether it is the education of the opposite hemisphere which is taking up the function of that part of the brain affected” (p1942)

And there is a discussions of:(1) re-teaching language as if the patient was again a school pupil, where the acquisition of language and grammar is viewed merely as a ‘memory process’; as opposed to (2) a Dr Herdman’s view that treating a person with aphasia should not be commensurate with school instruction as “the whole possibility of development in an aphasic depends on what remains of what actually did exist there …. [and] if the capacity never existed it could hardly be expected that the patient could be educated beyond tha stage of his former acquirements” (p1949)

Ideally, I’d really like to just reproduce the entire article here as it really is very interesting and much of it is very quotable.Although, this is probably not something that a speech and language therapist would cite to demonstrate application of Evidence Based Practice, Mills (1904) at least gives us insight into how aphasia was recognised around the turn of the last century in perhaps the early days of our profession.

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About chrissp1980
Currently a lecturer in speech pathology in North Queensland, Australia. I'm lecturing in acquired disorders of speech and language and also attempting to enthuse students in conducting clinically-relevant projects using principles of Evidence-Based Practice. Wish me luck!

One Response to Blast from the past – Mills (1904). Treatment of aphasia by training

  1. The Taxi Dog says:

    hi! i’m a 67 y.o. clinical psychotherapist stroke survivor with aphasia and a ‘devil-may-care’ attitude, and a wicked sense of gallows humor. glad to know you. your research finding are probably very interesting, but i can only a few lines at a time ’cause of headaches. Talk about gallows humor.

    i’ll read you with interest if you use a larger font. a few naked ladies would be nice too. but i won’t edit you out without them.

    you gotta keep up, young man!

    seriously, keep writing. tell me about your studies. your life. we’ll open a pub together, sell drinks to under-age gang-bangers, live a decadent life. laugh til we drop.

    Forget about your parents…never they never understood anyway. We’ll rob a train, take The Orient Express to Siberia, visit the left bank, the Bank of England, Banco Popular de Mexico. We’ll do strange things wirh exotic birds, who needs college, hahahah, hahahah, HAHAHAH!!!

    [BOINK]

    Phew!! thanks, i needed that!!

    i’ll be going back to my cell now. Nice to know you. Write soon! Toodles!

    that’s how my addled mind works nowadays. I love words, its a blessing to use them. He said, merriily skipping along the way.

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