Studies in the Osteopathic
The Physiology of Consciousness:
Louisa Burns, M.S., D.O., D.Sc.O.
The areas concerned in language include both
sensory and motor areas. These areas of different but related function
are found rather widely distributed over the cortex. They occupy parts
of almost or quite all of the overflow areas, including certain areas in
the right cortex as well as the left.
The Auditory Center
The auditory overflow extends posteriorly toward
the occipital lobe, inferiorly on the surface of the temporal lobe, and
upward toward the parietal lobe, from the posterior part of the temporal
lobe. (Figs. 12, 14.) That part of the upper and middle temporal convolutions
which is continuous with the anterior occipital lobe and the inferior parietal
lobe of the left hemisphere is concerned in the memories of the sounds
of words and of their significance. Injuries of this area cause loss of
the power to understand spoken words, though no deafness is present. The
person so injured has the same relationship to his mother tongue that normal
people have to a foreign language. The words may be distinctly heard, but
they have no significance. This area seems to be the one primarily developed
in the beginning of the use of language. It is not well developed in idiots
of the lower classes, among whom there is no possibility of learning to
understand more than the simplest heard language. Lower-class idiots are
not capable of using spoken language in the expression of thought, though
they may use a few simple expressions indicative of their wants or their
Very closely associated with the auditory language
area is the motor language area. This occupies the foot of the third frontal
convolution, or Broca’s convolution, as it is called This area lies within
the motor overflow for the laryngeal muscles, and the muscles of the tongue,
lips and face. The motor speech area is associated with the auditory speech
area by the superior longitudinal fasciculus. This bundle is composed of
the axons of cells of the auditory overflow, of the visual overflow and
of the somesthetic overflow, as they pass to the frontal lobes, to form
synapses with cells of the frontal cortex. By means of this bundle the
cells stimulated by the memories of words and their significance are able
to initiate the activity of the motor speech center at the foot of the
third frontal convolution, as well as certain other adjacent areas to be
The Motor Speech Center
The motor speech center is developed with the beginning
of active speech. The activity of this center must depend upon the activity
of the auditory speech center. In disturbances of the motor speech center
the person is able to remember how words sound, and he knows what words
to use, but he is not able to coordinate the movements needed for their
pronunciation. He is not able to think of the movements needful for the
pronunciation; in other words, his motor speech memories are lost. (Fig.
Cases of actual paralysis of the speech muscles are
recorded. In these cases speech is lost, but the motor memories remain.
The patient is able, in these cases, to form a mental image of the movements
needful for speech, but the movements are impossible. The cortical lesions
found in such cases involve the inferior part of the precentral convolution.
In other cases paralysis of the muscles of the larynx, lips, tongue, etc.,
may be associated with injuries of the lower centers.
The motor speech center is concerned in the first
use of language, in the normal person, and it is subject to stimulation
by the other centers. At first, the development of the centers used in
writing and in other forms of expression are initiated by way of the motor
centers. As development of the secondary center proceeds, the activity
of the first motor center is either not initiated by the transmission of
impulses through it on the way to other centers, or the impulses come to
be carried by other shorter paths, which do not include the original center.
It is noticed in poorly-educated people, who write with difficulty, that
the movements of the fingers are associated with movements of the lips,
tongue, etc., which are concerned in the pronunciation of the words they
are writing. This is true of children learning to write. It is only when
the impulses concerned in writing have become able to travel a pathway
which either does not include the motor speech center, or to traverse that
center without causing its stimulation, that writing becomes easy and as
if without thought for the act itself. This is, of course, the ideal of
expression, that the means of expression should be apparently without thought,
and that only the thing to be expressed should be represented in consciousness.
There is certain clinic evidence that in learning
a new language new neuron groups are functionally developed. At first,
as new languages are usually taught, the impulses are carried by way of
the older center to the neighboring neuron groups. This is the case in
the process of increasing the vocabulary of the language already used.
The new language is not to be considered as learned until it is possible
to express thoughts by the use of the new language without reference to
the old one. Thus, the habit of learning a new language by translating
the words of the old language into the words of the new necessitates the
transmission of the impulses underlying the thought to be expressed to
the auditory speech center, then to the motor speech center, where are
placed the cells for the coordination of the muscle movements of the words
of the language already familiar; then the impulses must be sent from this
center, either directly or, more probably, by way of the center for the
memories of words heard again, to the neuron groups, themselves in the
motor speech center, but somewhat removed from those already educated.
All of this transmission of impulses requires time and nervous energy.
In the process of this transmission the neuron activity concerned in the
consciousness of the thing to be expressed is partly inhibited, and the
thought suffers greatly from this loss of proper coordination. In this
method of learning a new language it is hoped that ultimately the impulses
concerned in the new motor speech center may come to be primarily initiated
without reference to the centers concerned in the older speech movements.
But this shortening of the paths requires a great deal of time, and under
certain circumstances is never perfected.
The “Natural Method”
Recently the so-called “natural method” has been
used in the teaching of new languages. The attempt is made to establish
from the very first a relationship between the thought and the expression
in the new words. No attempt is made to translate one language into another;
in fact, all tendencies to such translation are discouraged. In teaching
by this method the student sees an article and is told the name for it;
sees performed, or himself performs, an act, and is told the word for the
act; perceives qualities of any sort, and is told, and pronounces, the
name for those qualities. In order to prevent the tendency to the translation
of words from one language into the other, objects, qualities and acts
with which the student is not familiar are chosen as much as possible at
the beginning. Idiomatic expressions are employed in the beginning; these,
of course, are not capable of literal translation. The economy of this
system is apparent. No time is consumed in forming a series of paths by
way of the old language centers to the new. Paths which must be finally
eliminated if the new language is to become an efficient means of expression
are not formed, but the connections between the ideas to be expressed and
the motor impulses for their expression are made by the shortest possible
pathway from the very first. The use of the new language learned in this
way becomes easier, the idiomatic constructions seem simpler, and the person
thus taught has better command of the new language than if he had been
compelled to translate the new ideas into the old language first, the into
The application of this question in therapeutics
is apparent. In dealing with those people whose long illnesses have affected
the tenor of their thoughts in such a way as to prevent normal mental activity,
it is of little value to try to translate their present ideas into healthy
expressions and thoughts. In such cases the wisest thing is to try to teach,
as if from the beginning, the expression of new ideas. It is like learning
a new language for these people to use the expression of cheerful, and
pleasant, and wholesome ideas. They must be educated into the expression
of useful and healthful ideas by means of wholesome activities, and the
use of the words and expressions characteristic of the saner mentality.
Fig. 14. The language
Visual Speech Center
1. Motor area for the
muscles concerned in speech.
2. Speech center, for
the coordination of the movements of the muscles of speech.
3. Center for the memories
of heard words.
4. Writing center.
5. Center for the memories
of seen words.
The center for the memories of the appearances of
words lies upon the occipital lobe, just posterior to the center for the
memories of heard words; that is, in the left angular gyrus. Injury of
this center causes visual sensory aphasia. The patient loses the power
to recognize words as seen, though there is no true blindness. In uncomplicated
cases the patient would yet be able to recognize the significance of words
heard, but the proximity of the two centers renders uncomplicated cases
of visual amnesia or of auditory amnesia extremely improbable. (Fig. 14.)
These two centers are as intimately related in function
as they are in location. Both are essential to the performance of the normal
writing movements. As in the case of learning a new language, however,
the methods of teaching writing should depend as little as possible upon
an endeavor to translate the vocal motor speech impulses into the writing
motor impulses. The endeavor should be to develop the coordinate activity
of each center independently.
The motor center for writing lies near the foot of
the second frontal convolution. Lesion of this area is associated with
a loss of the power to write, though the power to read things written is
not lost. (Fig. 14.) The muscles of the hands and fingers are not paralyzed.
The only loss is of the power to coordinate the movements in such a way
as to produce written words. This loss of coordination, in one of Gordinier’s
cases, did not affect the ability of the patient (a woman) to knit. She
was able to hold her pen properly and to make movements which looked as
if she were writing, but only unrelated curves were produced by the movements.
The memories for the appearance of the words and the power to read intelligently,
both silently and aloud, were not injured. The lesion was found, at autopsy,
to involve only the foot of the second frontal convolution.
The angular gyrus of the right hemisphere is concerned
in the memories of the uses, and perhaps also of the names, of objects.
Injuries of this area cause mind-blindness. Objects are distinctly seen,
but are not recognized; their names are not known and their uses can not
be remembered. The condition may be associated with word-blindness, or
it may be uncomplicated. The intimate association of the lateral areas
renders uncomplicated cases rather rare.
In all of the centers concerned in language certain physiological factors
are to be considered. The normal activity of any one of these centers depends,
to a certain extent, upon the normal condition of the others. Rarely, lesions
are localized in centers which are functionally somewhat independent. In
such cases exact localization is possible, and the symptoms are very instructive
in the determination of the functions of the different cortical areas.
Clinically, the relationship is often found more complex. Lesions extend
from part of one center into part of another, and the symptoms are correspondingly
The normal activity of the speech centers, as of
the other parts of the cortex, depends upon the maintenance of the normal
nutritive conditions, and upon the normal relationship of the sensory,
associational and motor impulses. It often occurs that the action of these
centers, especially of the motor speech center, is incoordinated. This
may result from any one or more of a number of different causes.
Children who have been made self-conscious and awkward
by excessive criticism, especially of an unkind nature, often begin to
stammer. This is due to the inhibitory effect of the overstimulated frontal
centers. Such inhibitions affect the speech centers in such a manner as
to postpone the activity of certain neurons, while the stream of impulses
associated with the idea to be expressed stimulates the same center to
increased activity. Hence the irregular and incoordinated movements of
the vocal muscles may be caused.
Emotional states affect the speech mechanism adversely.
The inhibitory impulses from the basal centers may be so powerful as to
inhibit completely the power of speech. This is especially true of spoken
language, though the same effect may be found in written language at times.
Stammering may be caused from the presence of certain
peripheral irritations. Abnormal sensory impulses may reach the cortex
from almost any part of the body in such numbers or such force as to affect
the entire cortical activity. Increased irritability results from excessive
stimulation, in the absence of exhaustion, and the increase in irritability
causes increased activity under slight stimulation. The inhibitory impulses
mentioned in connection with the results of excessive adverse criticism
are present as a result of excessive sensory stimulation.
The presence of poisons in the blood stream, eye
strain, overwork, excessive responsibility in children, and a number of
other sources of abnormal functional activity on the part of the cortical
neurons may be efficient factors in perpetuating the stammering habit
The cure of stammering must depend upon the removal
of the abnormal nervous irritations, if any are present, and the education
of the centers.
The educational processes to be considered are, first, the establishment
of the normal relationship between the centers, and, second, the removal
of the inhibitory impulses. The members of the family of the person who
stammers should not pay attention to the habit, since this increases the
inhibitory impulses. If the educational methods must be used by some member
of the family, the teaching should be given by one person only, at certain
stated times each day. Indiscriminate criticism is much worse than if no
attention were given to the condition at all.
The stammering person should be taught, first of
all, to recognize vividly in consciousness the actions which he performs
in the endeavor to speak. He should stand before a mirror, at first in
the presence of the doctor who has his case in hand, and should watch himself
trying to talk. He should do this until he is able to see clearly exactly
what manner of motions he is performing. This should be done in as kindly
a manner as possible; no ridicule should be permitted, and no person should
be present except those who must be. Preferably only the doctor in charge
of the case should be with the child when instruction is being given, especially
at the first.
The conscious recognition of the nature of the facial movements being
secured, they may be inhibited voluntarily to a very great extent. He should
imitate voluntarily the movements, again and again, until he can imitate
his own facial contortions. What he is able to do, voluntarily and consciously,
he is able to refrain from doing. If he is unable to refrain from the incoordinated
movements, he is not yet able to perform them well. Usually, the production
in consciousness of stammering movements is enough to cure the habit. If
necessary, however, the movements concerned in normal speech should be
practiced before the mirror until it is possible to talk without any facial
contortions. The methods of scanning, of sing-song speech, of singing and
of rhyming lessen the inhibitory impulses from other cortical centers,
and are of a certain value in helping the stammerer to self-confidence
and to right habits.
The person in whom the speech centers have been acting
in an incoordinated manner for any length of time is very apt to have a
certain amount of difficulty in speech under emotional stress or times
of fatigue for all his life. If this knowledge inculcates a certain amount
of self-control, perhaps no great harm is apt to result from the slight
It must be noted that the motor speech center occupies
part of the third frontal convolution, that the writing center occupies
part of the second frontal convolution, and that the visual overflow and
the auditory overflow are all concerned very markedly in the nervous mechanism
of language. The naming of words, object, actions and qualities makes the
language mechanism associated with practically all of the cortical areas.
So intimately is this language mechanism associated with other parts of
the cortex that the most efficient activity of the cortical neurons depends
upon the exactness and efficiency of the naming process.
In myths of every people whose myths have been studied
in this connection there are found accounts of the efficiency of this naming
process. In most myths there is a ferocious monster, or some devil, or
some malevolent creature who assails, or attacks, or harasses a person
or a country. Some wise or brave person calls him fairly and plainly by
name, whereupon the malicious creature disappears with a howl, or the devil
with an odor of brimstone, or the monster may commit suicide. The fact
that giving a name to that which is a cause of disturbance lessens the
cause for fear has its root in the fact that the naming process, relating,
as it does, so many cortical areas, is associated with more efficient cortical
activity, and thus with clearer consciousness than would be possible in
the absence of language.
Clear Language Makes Clear Thoughts
Exact naming is one factor in securing vivid consciousness
of sensory impulses, thus in appreciating the facts of environment and
their significance. The use of words of doubtful meaning, or words which
have different uses, without a clear understanding of the manner in which
they are being used at any given time, the distortion of words from their
commonly accepted significance, the endeavor to employ other terms for
the sake of euphony, careless language at any time, all of these things
make clear thinking, efficient activity of the cortical neurons, practically
impossible. Only as spades are called spades is their use in digging clearly
appreciated; only as a wrong is clearly seen can it be righted; only as
faults are recognized and named can they be eliminated. The monsters of
the myths were destroyed only by calling them by name; the monsters of
our civilization, of our government, of our profession, of our individual
lives, can be destroyed by calling them by name, and in no other manner.
In the old myths, the good fairies, the benevolent
gods, the helpful angels, were to be called to one’s assistance if only
one knew their right names. All the good things of life were held to be
at the disposal of the person who was able to call by a true name the spirit
who had them in charge. This, too, is a truth. If the things which are
desired are called by their right names, the manner of securing them usually
becomes evident. It is true that things become often less desirable when
they are called by their right names. But desires which are truly and exactly
expressed become by that very fact rather more attainable, or their impossibility
becomes more certainly evident. The exact naming of ideals, of earnest
desires, of the objects of enthusiasm, is the first long step toward their
In the teaching of children the most important factor
to be considered in language is that they shall use words in their exact
sense. Many words have more than one meaning; children must be taught to
discriminate, and to know in what significance they employ the word. The
time of childhood is the time for the teaching of the foreign languages
and for the establishment of a large vocabulary. There is a certain educational
value in the process of learning a new language. The use of the different
neuron groups gives a broader field for the associational activities. The
use of the vocabularies associated with the different vocations of life
is of similar value, but this is less efficient than the use of the new
language. The development of different neuron systems which is secured
by the attainment of a new language is not to be found in any other line
In the training of the mentally deficient, attempts
should be made to increase the vocabulary in as great a degree as is consistent
with the powers of the child to understand the words. The words chosen
must always be those for which a clear use is possible, and the child must
use them in their exact sense. The more vividly the words can be appreciated
in consciousness, and the more exactly the expressions can fit the thought
to be expressed, the better is the educational value of the language in
the development of the mental capacities.
The use of language as an educational factor in
therapeutics is fairly evident. When people are for a long time sick they
are apt to become accustomed to answering those foolish questions concerning
health which politeness seems to demand by a detailed and more or less
truthful account of their sufferings. Now, the very fact of detailing symptoms
lowers the liminal value of the neurons concerned in the appreciation of
the discomforts, and thus increases their irritability. So that every time
the sick person tells his pains to his neighbors, he adds just so much
to his own discomforts, he increases the tendency of his neighbor to suffer
in the same way, and he postpones certainly the hour of his own recovery.
The neighbor usually listens with only half an ear, since he usually is
thinking of the pains he himself has suffered, and is getting his thoughts
in order for their recital, or he may frankly be bored by the uninteresting
tale. This lack of sympathy does a certain amount of good, that it prevents
too great an amount of the psychical contagion of suffering.
Such people may need nothing in all the world so
much as to forget their discomforts, and yet this is the most impossible
thing for them to do. “I never allow myself to think of my sufferings,
no matter how bad I feel. I just make myself forget it.” People who talk
in that way are remembering, and suffering, and making themselves suffer
all the day and most of the night. No one can ever forget by determination.
The only forgetting comes by way of new and different remembering. If any
one would empty a pail of air, he would best do this by filling it with
water. The cortical neurons are constantly active. It is impossible to
voluntarily prohibit the activity of any particular group of neurons. The
neuron groups are stimulated according to their relative liminal values.
If any neuron group has the lower liminal value, it is more affected by
incoming stimuli. If it is desired to lower the liminal value of other
and antagonistic groups of neurons, this is easily done. But it is probably
impossible to increase directly the liminal value of neuron groups. So
it is of little value to try to teach such people to try to forget their
sufferings; they must actually forget them in the use of other neuron groups.
It seems to be very successful in some cases to compel
the patient to actually lie himself out of his pain. But there must be
some lack of normal conditions in the person who is thus able to lie to
himself, and the effect of deliberate self-deceit must be harmful.
This attitude is unnecessary. There are enough good
things in the world to think about without devising false things which
are merely supposed to be good. Let the ideas of personal comfort or discomfort
alone. It is not good even to attend to bodily sensations long enough to
deny them. Let them alone. Let the patient attend carefully to things outside
of his own bodily condition and tell others about them. Let him put into
words everything which he can find which concerns things strong, and fine,
and beautiful. He must not try to think himself well, or talk about himself
as well, but he may think of himself as going to work, as engaging in some
line of endeavor in which he is interested. He may plan for the future
as much as he will, but he should cease at once and absolutely any consideration
of his present feelings, either good or bad. He must answer the questions
the doctor asks, but to every one else the question of personal sensations
should be tabooed. Why should it be polite to ask after a person’s health
any more than after his bank account?
Persons who are ill for any length of time should
be absolutely forbidden to answer any questions concerning their bodily
states, or to permit others to talk about the subject of health or sickness.
After recovery seems fairly well advanced, it may
seem advisable to permit the expressions of strength and good health. The
expressions of interest in work or play must always be of greater value
than expressions of returning health, however good this may be.
The best thing in the world for such people is for
them to begin to plan for the future. Make them talk about the future,
about the things they are planning. Make them talk about the emergencies
which they may meet, and how they will meet them. Make them use the larger
muscles, as has been explained in a previous chapter. Make them talk even
about other people, if they can not be interested in things better fit
for conversation Better the most exaggerated village gossip than talk about
their own physical conditions.
Physiologically, language serves much the same purpose which
is served by muscular movements. It gives expression to the nerve impulses arising
from the activity of the ganglionar centers and the intermediate areas, and
thus eliminates the harm of the repressed emotions and judgments. The development
of the neurons of the language centers makes possible the storing of memories
and determinations in a more exact and powerful manner than is possible in the
absence of language. In education and in therapeutics the language centers may
be used as efficiently as are the other cortical or the ganglionar centers.
In treating certain diseases characterized by mental symptoms the language centers
may be employed, as osteopaths already are employing the spinal centers, for
the modification of nervous activity, and thus, indirectly, for the improvement
of the bodily state.