Hektoen International

A Journal of Medical Humanities

Bicentenary of the birth of Pierre Paul Broca (1824–1880)

JMS Pearce
Hull, England

Fig 1. Paul Broca. Photo by Pierre Petit. Via Wikimedia.

This year marks the bicentenary of the birth of Pierre Paul Broca, who established the cerebral localization of motor, expressive speech, and language function.1 He was the son of Jean “Benjamin” Broca, a surgeon in Napoleon’s army, and Annette Thomas. Broca was born on 28 June 1824 in Sainte-Foy-la-Grande in the Dordogne. His name is perpetuated by the eponyms “Broca’s area” and “Broca’s aphasia.”

Broca was not a practicing neurologist. He worked in surgery, anatomy, and anthropology. At the University of Paris Medical School, he graduated MD and became professor agrége and surgeon to the hospital. He was later elected to the chairs of the External Pathology and of Clinical Surgery, a position he held until his death. He was an indefatigable worker, who apart from his work on aphasia made substantial incursions in medicine, biological science, and anthropology.1

The idea of localization of functions to specific brain areas was recent. Franz Joseph Gall (1758-1828) with Spurzheim had proposed that individual human traits were located within the brain, evident in the visible skull and face.2 More importantly, Jean-Baptiste Bouillaud in 18253 and Richard Bright in 18314 had shown that disorders of speech were caused by abnormalities in the frontal lobes. The precise localization, however, remained unknown.

Leborgne (aka Tan tan) and Lelong

At the Société d’Anthropologie on April 18, 1861, Broca presented a longstanding aphasic hemiplegic patient named Leborgne from his ward in the Bicêtre Hospital. (Green prepared a full translation.) For twenty years, Leborgne was only able to utter “tan, tan,” and was thus nicknamed. Tan died in April 1861 and Broca showed the uncut brain at the Société d’Anthropologie.5 There was a softening involving the left third frontal convolution and the insula; the posterior part of the left third frontal gyrus was most affected.6 He concluded:

This loss of speech in individuals who are neither paralyzed nor idiots constitutes a very specific symptom for which I consider it useful to invent a special name. So I will name it aphemia… for it is only the faculty of articulating words that these patients lack. They hear and understand everything that is said to them; they are in full possession of their senses; they produce vocal sounds without difficulty; they execute with their tongue and lips movements that are far more elaborate and energetic than is required for the articulation of sounds.    

This was a highly significant conclusion, probably the first time a complex cerebral function was localized in a specific part of the cortex. In November 1861, he presented a second case, an eighty-four-year-old man named Lelong, who had a stroke one year earlier. He found that the lesion occupied exactly the same seat as with the first patient: a profound but circumscribed lesion of the posterior third of the second and third frontal convolutions. He coined the term aphemia (Greek φήμη phḗmē, voice).

Broca subsequently distinguished two main speech disorders: aphemia and verbal amnesia. At a later meeting of the society on 21 April 1867, he heard a complaint by Gustave Dax to the Academy that claimed that Broca had overlooked Dax’s father Marc, who had read a paper on the topic in July 1836. In fact, this had not been published.

Broca presciently conserved Tan’s brain; forty years later, Pierre Marie dissected it and showed the lesion extended beyond the third frontal convolution into the parieto-temporal region and external capsule. Marie criticized Broca, inaccurately stating the left third frontal convolution plays no special role in the function of language.7

In 1980, Castaigne et al performed a CT of Leborgne’s brain,8 and in 2007 Dronkers and coworkers applied high resolution magnetic resonance imaging to both Broca’s patients. They found that in both, lesions extended significantly into medial regions of the brain, in addition to the surface lesions observed by Broca.9 These important refinements diminish neither the significance nor originality of Broca’s discovery. Aphasiology expanded when Wernicke described receptive aphasia located in the superior temporal lobe convolution, and with subsequent concepts of its nature and variants by Hughlings Jackson, Charcot, Ferrier, and by Henry Head, detailed in Macdonald Critchley’s lucid monograph.10

On July 8, 1880, Broca died; the description suggests the cause was myocardial infarction. He was honored as a lifetime senator of the French republic, bestowed on distinguished wise men, counselors, and physicians. His name is inscribed on the Grenelle side of the Eiffel Tower.

References

  1. Schiller F. Paul Broca, founder of French anthropology, explorer of the brain. Berkeley: University of California Press, 1979.
  2. Gall FJ, Spurzheim JG. Anatomie et physiologie du systéme nerveux en général et du cerveau en particulier. Atlas. Paris: F. Schoell; 1810.
  3. Bouillaud JB. Recherches cliniques propres à démontrer que le sens du langage articulé et le principe coordinateur des mouvements de la parole résident dans les lobules antérieurs du cerveau. Bull Acad R Méd 1848, 1er trimestre, pp. 699–719. Reprinted in Hecaen H, Dubois J. La Naissance de la neuropsychologie du langage. Paris, Flammarion, 1969, pp. 34–53.
  4. Bright R. Reports of medical cases selected with a view of illustrating the symptoms and cure of diseases by reference to morbid anatomy, vol 2: Diseases of the Brain and Nervous System, Part 2. London, Longman, Rees, Orme, Brown & Green 1831, p. 538.
  5. Pearce JMS. Broca’s Aphasiacs. Eur Neurol 2009; 61 (3): 183–189.
  6. Broca PP. Remarques sur le siège de la faculté du langage articulé, suivies d’une observation d’aphémie (perte de la parole). Bull Soc Anat 1861;6:330–357.
  7. Marie P: La troisième circonvolution frontale gauche ne joue aucun rôle spécial dans la fonction du langage. Sem Méd 1906;26:241–247.
  8. Castaigne P, Lhermitte F, Signoret JL, Abelanet R. Description et étude scannographique du cerveau de Leborgne: la découverte de Broca. Rev Neurol (Paris) 1980;136:563–583.
  9. 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.
  10. 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 medicine and science.

Fall 2024

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