Hull, England, United Kingdom
|Fig 1. Paul Pierre Broca. US National Library of Medicine.|
At the turn of the nineteenth century, knowledge of how the brain worked was largely conjectural. Intelligence, memory, language, and motor and sensory functions had not been localized. The physiologist Flourens, promoting the notion of “cerebral equipotentiality,” concluded, “The cerebral cortex functions as an indivisible whole . . . an ‘essentially single faculty’ of perception, judgment and will . . .”1
The first step in cerebral localization was made by Gall and Spurzheim, who by means of highly-skilled anatomy showed correlation of function and structure within the brain and its relation to mental processes: the brain was the organ of mind.2 But they mistakenly related personality and brain function to the configuration of bumps in the skull. Not surprisingly, after a surge of popular acclaim this craniology or phrenology was discredited.
In France, Jean-Baptiste Bouillaud (1796–1881) proposed the localization of speech to the frontal lobe in 1825. He offered 500 francs to whoever might demonstrate that speech disorders were not related to the frontal lobe. However, he arguably lost his wager and had to pay the sum to the surgeon Alfred Velpeaui seventeen years later.3
Leborgne, Broca’s famous “Tan Tan”
Almost forty years later, the surgeon Paul Broca (1824-1880) had a longstanding aphasic, right-hemiplegic, fifty-one-year-old patient named Louis Victor Leborgne in the wards of the Hôpital de Bicêtre. For twenty years Leborgne’s only word was “tan tan,” and was thus nicknamed. Ernest Auburtin, who was Bouilaud’s son-in-law, had examined him at Broca’s request. Leborgne died of a gangrenous leg in April 1861; Broca showed the uncut brain at the Société d’Anthropologie.4,5 Few publications in the annals of clinical neuroscience have had such lasting effects. Broca wrote:
“He could no longer produce but a single syllable, which he usually repeated twice in succession; regardless of the question asked him, he always responded: tan, tan, combined with varied expressive gestures. This is why, throughout the hospital, he is known only by the name Tan . . . [at autopsy] most of the other frontal convolutions were entirely destroyed. The result of this destruction of the cerebral substance was a large cavity, capable of holding a chicken egg, and filled with serous fluid. The softness had spread up to the ascending fold of the parietal lobe, and down to the marginal fold of the temporal-sphenoidal lobe; finally, in the depths, [it spread to] the region of the insula and the extraventricular nucleus of the striate body; it was the lesion of this last organ which was responsible for the paralysis of the movement of the two limbs of the right side. . . .
“The integrity of the third frontal convolution (and perhaps of the second) seems indispensable to the exercise of the faculty of articulate language . . .”5
In November 1861, he presented a second case, an eighty-four-year-old man named Lelong, who had a stroke one year earlier.
I found that in my second patient, the lesion occupied exactly the same seat as with the first- immediately behind the middle third, opposite the insula and precisely on the same side.
He coined the term aphemia (phéme = voice).
In this patient, therefore, the aphemia was the result of a profound, but accurately circumscribed lesion of the posterior third of the second and third frontal convolutions.
Broca later distinguished two types of speech disorder: aphemia, and verbal amnesia—in which the patient lost the memory not only of spoken but also of written words. Bouillaud accepted Broca’s conclusions that confirmed his own idea of cerebral localization. After Broca’s communication, Auburtin on 4 April 1864 addressed the Anthropological Society of Paris and localized in the frontal lobes “the faculty of coordinating the movements peculiar to language.”
It was forty years later that Pierre Marie cut Tan’s brain and confirmed that the destructive lesion extended beyond the third frontal convolution (as described by Broca) into the white matter and external capsule. Remarkably, more recent high resolution magnetic resonance imaging of the preserved brains of Broca’s two historic patients showed that the lesions extended into the superior longitudinal fasciculus—far deeper than Broca was able to report—and suggested that other areas besides Broca’s area may have contributed to his patients’ speech deficits.6,7 The researchers state that
this by no means detracts from Broca’s phenomenal discovery. Because he elected not to slice the brains, Broca could not have known the extent of underlying damage . . . and the role it might play in their speech disorders.
The well-known Broca-Dax controversy ensued when Gustave Dax accused Broca of overlooking a paper from his father Marc Dax in July 1836, which concerned two patients suffering from loss of memory for words and had left hemisphere injuries. The manuscript had not previously been revealed to public scrutiny but Gustave Dax nonetheless published it.8
Paul Pierre Broca
Broca was born on June 28, 1824, in Sainte-Foy-la-Grande.3 His father had been a surgeon in Napoleon’s army. He wanted to study at the Ecole Polytechnique to become an engineer, but changed his mind and studied medicine in Paris, graduating MD in 1849. Known for his generosity, compassion, and integrity, he was distinguished as a surgeon, pathologist, and anthropologist. He founded the Anthropological Society of Paris in 1859. He was appointed in 1867 to the Chair of Pathology at the Faculty of Medicine and a year later became professor of clinical surgery. An industrious and prolific author, his papers included treatises on tumors, aneurysms, microscopy, hypnotism in surgical anesthesia, and anthropology. He was married to the daughter of the inventor of Lugol’s iodine. One son, Auguste, was professor of pediatric surgery and the other, André, a professor of medical physics. Six months before his death he was elected a member of the French Senate for life, and vice-president of the French Academy of Medicine. He died suddenly (possibly of aneurysmal subarachnoid hemorrhage), aged fifty-six, in Paris on July 8, 1880.
These early explorations of aphasia were the start of the subsequent delineation and localization of other brain functions. Aphasiology continued with Wernicke’s description9 of receptive aphasia that he located in the superior temporal lobe convolution, and with subsequent evolving concepts of its nature and variants by Hughlings Jackson, Charcot, David Ferrier, and by Henry Head, detailed in Macdonald Critchley’s lucid monograph.10
- Velpeau had a patient with a bifrontal tumor whose speech was not affected. That Broca’s area was involved was an issue of contention.
- Flourens MJP. Recherches expérimentales sur les propriétés et les fonctions du système nerveux, dans les animaux vertébrés (ed 2). Paris, Ballière, 1842.
- Gall FJ, Spurzheim JG. Anatomie et physiologie du systéme nerveux en général et du cerveau en particulier. Atlas. Paris: F. Schoell; 1810.
- Schiller F. Paul Broca, founder of French anthropology, explorer of the brain. Berkeley: University of California Press, 1979.
- Broca P. Perte de la parole: ramollissement chronique et destruction partielle du lobe anterieur gauche du cerveau. Bulletins de la Societe d’anthropologie, 1re serie 1861b; 2: 235–8.
- Broca P. Nouvelle observation d’aphe ́mie produite par une le ́sion de la troisie`me circonvolution frontale. Bulletins de la Socie ́te ́ d’anatomie (Paris), 2e serie 1861a; 6: 398–407.
- Dronkers N F, Plaisant O, Iba-Zizen M T. Cabanis E A. Paul Broca’s historic cases: high resolution MR imaging of the brains of Leborgne and Lelong. Brain 2007;130:1432-1441.
- Pearce JMS. Broca’s aphasiacs. Eur Neurol 2009;61:183-189.
- Dax M. Lésions de la moitié gauche de l’encéphale coincident avec l’oubli des signes de la pensée (Lu au Congrès méridional tenu à Montpellier en 1836, par le docteur Marc Dax). Gaz Hebdom Méd Chir 1865;2:259. English translation in Joynt J, Benton AL: The memoir of Marc Dax on aphasia. Neurology 1964;14:851–854.
- Wernicke, C. Der aphasische Symptomencomplex. Breslau; Tasehen. 1874.
- Critchley M. Aphasiology and other aspects of language. London, Edward Arnold; 1970.
JMS PEARCE is a retired neurologist and author with a particular interest in the history of science and medicine.