PAUL BROCA

JUNE 28, 1824Gironde, France

JULY 9, 1880Paris, France

56 Years

• Born, Pierre Paul Broca, French

• Physician, surgeon, anatomist, and anthropologist.

• Best known for his discovery of the frontal lobe region associated with the articulation of language (Broca’s)

• Discovered that brains of aphasia patients exhibited lesions in left frontal region of the cortex

• First researcher to accurately associate a brain function with a specific anatomical area of the brain

• Grew up in Sainte Foy La Grande, a midsize French town with a large protestant population in the region of Gironde

BROCA: EARLY YEARS

• Mother was the daughter of a Protestant preacher

• Son of Benjamin Broca, a medical practitioner and former Napoleon’s surgeon who served in Waterloo

• Educated in hometown school

• Earned bachelor’s degree at age of 16

• Entered medical school in Paris at age 17

• Graduated age 20, when most of his contemporaries were just beginning medical school

BROCA: EARLY YEARS

BROCA: WIFE

• Born in Paris

• Married Broca in 1857

• Had 3 children

ADELE AUGUSTINE LUGOL BROCA

(1835 – 1914)

• Broca’s wife’s father

• Born in Montauban, France

• Studied Medicine in Paris

• Acting physician at Hospital Saint-Louis in Paris until retirement

BROCA: IN-LAWJEAN GUILLAUME AUGUSTE LUGOL

(1786 – 1851)

• Developed iodine solution to be used to treat tuberculosis

• Not efficacious in tuberculosis but great for treatment of thyrotoxicosis and other ailments

• Bactericide, Fungicide

BROCA’S IN-LAW: IODINE MEISTER

• First with urologist and dermatologist Phillipe Ricord (1800-1889) at Hospital du Midi

• 1843 - With psychiatrist Francois Leuret (1797-1851) at the Bicetre

• 1844 - With anatomist and surgeon Pierre Nicolas Gerdy (1797-1856). Becomes assistant after two years

BROCA: EXTENSIVE INTERNSHIP

PHILLIPE RICORD

1800Baltimore, USA

1889Paris, France

89 Years

Napoleon III Doctor and medical advisor

• One of the most charismatic men of the nineteenth century

• Oliver Wendell Holmes, who attended the Midi in 1838, called him "the Voltaire of pelvic literature

“...a skeptic as to the morality of the race in general, who would have submitted Diana to treatment with his mineral specifics, and ordered a course of blue pills for the vestal virgins.”

PHILLIPE RICORD: AWESOME GUY

• 1847-1848, publishes series of 28 Lectures in the Lancet

• Proves gonorrhea and syphilis are different diseases

• Rejects balanoposthitis and condylomas as syphilitic

PHILLIPE RICORD: AWESOME UROLOGIST

• Clarifies manifestations of syphilis in women via masterful speculum technique

• Establishes the orderly grading of the stages of syphilis, although knowledge of neurosyphilis was yet to come

• Failed to recognize chancroid as a specific cause of genital ulceration.

• Was also wrong about many contentious issues of his day

RICORD: AWESOME UROLOGIST

BACK TO BROCA!

• 1848 - becomes Prosector of anatomy at the University of Paris Medical School and is also appointed secretary of the Societe Anatomique

• 1849 - awarded M.D.

• Founded society of free-thinkers supportive of Charles Darwin’s theories.

• Fascinated by the concept of evolution remarks “Rather be a transformed ape than a degenerate son of Adam.”

• Open support of Darwin brings him into conflict with the church: “A subversive, materialist, and corrupter of the youth” they call him

• Animosity with church continued throughout his career, resulting in numerous confrontations with ecclesiastical authorities

• 1859 - Conducts first experiments in Europe using hypnotism as surgical anesthesia with Etienne Eugene Azam, Charles-Pierre Denovilliers, Francois Anthime Eugene Follin, and Alfred Armand Louis Marie Velpeau

• Pursued in parallel with his medical career

• Published 223 papers on general, physical and cultural anthropology

• Invented more that 20 measuring instruments for craniology, and a variety of measuring indices

• Established methodologies and standards for accurate chraniometry

• Contributed significantly to the study of primate comparative anatomy

BROCA: ANTHROPOLOGY

Also became the father of French Anthropology:

• In 1859, founded the Society of Anthropology of Paris and from 1862 serves as its secretary

• In 1872, founded the Journal Revue d’anthropologie

• In 1876, founded the Institute of Anthropology

• Catholic Church deploys campaign to stop the institute and impede the overall development of anthropology in France

BROCA: ANTHROPOLOGY

FUNCTION LOCALIZATIONAt the beginning…

EMMANUEL SWEDENBORG

1688 Stockholmto

1772

70 Years

EMMANUEL SWEDENBORGScientist, philosopher theologian

First one to recognize that different functions must be represented in different locations of the cerebral cortex, and idea missing from the writings of Thomas Willis

Maintained that the motor cortex is responsible for voluntary movements

Linked frontal lobes with intellectual functions of the brain

His work did not receive the attention of the medical community

Became a world known theologian mystic, re-interpreter of Christianity and scripture

FRANZ JOSEPH GALL

1758Tiefenbrunn, Germany

1828Paris, France

70 Years

FRANZ JOSEPH GALL

Claimed as the father or Phrenology

Born into wealthy family, father was The Mayor of Tiefenbrun

Early fascination with physical and mental differences between himself, classmates and siblings

Developed interest in the brain after correlating a classmate's odd shaped skull and his advanced language abilities

GALL: SCHOLARSHIP

Completed medical studies in Vienna under Johann Hermann and Maximilian Stoll who impressed upon him the importance of natural observation

Worked first at the Lunatic Asylum where he constantly observed the insane

Eventually move on to private practice and research

Nominated the Emperor ’s physician but declined

GALL: ORGANOLOGY

Around 1792 after exhaustive research, Gall concludes the mind is a collection of independent entities housed within the brain (organs)

Each one controls specific mental functions

Each one operationally interconnected to the others and its own hemispheric twin

GALL: CRANIOSCOPY

Gall Identified 27 faculties of mind and located them on specific “organs” located on both brain hemispheres

Gall Developed a method to assess personality and development of mental and moral faculties on the basis of the external shape of the skull (cranioscopy)

• Plate from Gall’s atlas showing a “woman who loved children” (top) and “one who was indifferent to them” (bottom).

• The “faculty for love of one’s offspring” was supposedly located in the back of the cerebrum

F.J. Gall, Anatomie et Physiologie du System Nerveux, F. Shoell, Paris 1810

FROM GALL’S ATLAS: APPROXIMATE LOCATIONS OF “FACULTIES”

• Helped establish “neuro-psychology” as a science

• Contributed to the emergence of the naturalistic approach to the study of humans

• Played an important part in the development of anthropology, sociology and evolutionist theories

Phrenology is now a pseudoscience, but Gall’s work:

Johann Spurzheim

1776Near Trier, Germany

1832Boston, Massachusetts

56 Years

JOHANN SPURZHEIM

• Born in the Mosel region of the lower Rhine next to the French border

• Studied Medicine at the University of Vienna

• Began to help Gall in 1800 and for 13 years became his personal assistant

• Parted company in 1813, claiming neglect of credit for significant work and discoveries during his tenure with Gall

SPURZHEIM: DEPARTURE• In 1815 presented his new

model which included a craniological system that differed from Gall’s

• Added organs, such as “hope” “tune” and “right” (moral sense), to Gall’s list increasing total number from 27 to 33

• Reorganized the faculties into a hierarchical system

SPURZHEIM: MARKETING?

• Used images and busts extensively to showcase the craniographic approach to phrenology

• Popularized the word “phrenology” a term from the Greek words phren (mind) and logos (discourse) intended to suggest a solid mental science

SPURZHEIM: MARKETING

• Travelled extensively popularizing phrenology across Europe

• Died of typhus in Boston in 1932 during first phrenology US tour

• George Combe, 1788-1858

• English Laywer , non-doctor

• Begins to follow Spurzheim in 1816

• Third most important person in phrenology

• Leader of the phrenology for more than 20 years

• Writes the best-selling phrenology book ever

PHRENOLOGY: ENGLAND

PHRENOLOGY USA !

1822 John C. Warren, John Bell, and Charles Caldwell

Three prominent American physicianshear Franz Joseph Gall speak in Paris and return to the United States to spread the Gospel

PHRENOLOGY USA!

• Warren develops a research program in Boston to study phrenology

• Bell and Caldwell found the Central Phrenological Society in Philadelphia

In a lecture, Bell describes Spurzheim seeing 30 infanticidal women, 26 of which had defective development of the infero-posterior organ of “philoprogenitiveness” (ability to love children)

PHRENOLOGY USA

• In 1824, Caldwell wrote Elements of Phrenology, the first American textbook on phrenology and in 1827 he published an expanded second edition of this book.

PHRENOLOGY USA

AND THEN…

MARIE JEAN PIERREFLOURENS

1794 - 1867(72 Years)

FLOURENS: THE SETUP • French experimentalist

• Studied medicine at the Univ. of Montpellier

• Commissioned by the Academie Française in 1822 under orders of Emperor Napoleon Bonaparte, to test Gall’s theory on the basis of direct physical experimentation

• Investigating localization, pioneered methods to cause lesions in living animals to determine specific functions of brain regions

FLOURENS: THE HAMMER

• Citing animal studies involving the destruction of various cerebral segments and components, proclaims that when one cortical function is affected , so are all others , and if one function recovers, so do all of the rest

• Subtle Message:

The concept of a mosaic of cortical organs is completely false, all areas of the cortex are responsible for intelligence, voluntary actions, and perception…

Opposition against phrenology grew so strong after Flourens’ condemnation of Gall’s system that the parallel idea of using brain-damaged patients or animals to argue for cortical localization of function was shunned by most scientists for decades.

But the notion of specialized cortical areas was never really allowed to die, at least not in Paris…

FLOURENS: THE AFTERMATH

MEET PAUL BROCA’S MOST FAMOUS PATIENTMr. Leborgne, alias “Tan-Tan”

• April 4, 1861 - Meeting of the Societe d’ Anthropologie, Ernest Aubertin presents paper citing numerous compelling cases in support of cerebral localization of language hoping to close the discussion

• But respected anatomist Paul Gratiolet fires back: “All attempts at localization lack any foundation. All it takes is one case to destroy it”

• Paul Broca, Secretary of the Societe, sits in the audience…

BROCA’S DARE

• 1840 - Wordless patient Louis Victor Leborgne, is admitted to the Bicetre Hospital outside Paris for aphasia, an inability to speak

• April 12, 1861 - 21-years after Bicetre admission and eight days after Aubertin’s Societe presentation, the man known as “Tan” after the only word he could utter, arrives at Broca’s ward

• Broca examines him extensively the next day

BROCA’S PATIENT

• April 17, 1861 - Leborgne dies five days after meeting Broca

• April 18, 1861 - Broca performs Leborgne’s autopsy

• 3 Months later, Broca presents his findings to the Société d’Anthropologie

BROCA’S BREAK-THROUGH

• Broca finds a lesion in the left frontal lobe of the brain

• The examination is key in Broca’s localization of the brain area responsible for speech production (Broca’s area)

BROCA’S AREA

Red circle denotes lesions and malformities

BROCA’S AREA: PATIENT 2Lazare Lelong. 84-years-old. Grounds worker. Suffering from dementia. Retains ability to say five words: “yes”, “no”, “always”, “three” (which he uses to mean any number), and “Lelo” a mispronounced version of his own name. Bicetre Hospital.

• The faculty of articulate language and its frontal lobe localization were not novel in 1861

• What Broca provided was solid findings that galvanized localization in the scientific community

• Other factors that maximized Broca’s impact include

Detailed account of findings

Use of speech-loss-specific evidence rather than post hoc case review

Pathological rather than craniological methods

Focus on the convolutional topography of the cerebral hemispheres to support localization

The scientific community’s readiness

NORMAN GESCHWIND

1926 - 1984

58 Years

• Eminent American neurologist

• Born NY City from Polish parents

• Boys' High School in Brooklyn 1942

• Harvard College on a Pulitzer Scholarship

• United States Army during World War II

• Harvard MD, 1951

NORMAN GESCHWIND

• Boston's Beth Israel Hospital

• Muscle physiology with neurologist Ian Simpson at Queen Square National Hospital in London

• General neurology under Derek Denny-Brown, Boston City Hospital

• 1958 - Joins Fred Quadfasel at Boston's VA , begins work on the neurology of behavior, founds Aphasia Center

• 1969 - Returns to Harvard as Professor of Neurology and neurological unit chief at Boston City Hospital

GESCHWIND, INTERNSHIP

• Initially influenced by holistic views of Hughlings Jackson, Kurt Goldstein, Henry Head, and Carl Lashley

• 1960s - seduced by the analytical style of Broca, Wernicke, Bastian, Dejerine, Charcot, heavily reliant on anatomical brain interconnection via neural networks

• Analysis of a patient with a brain tumor who could write correct language with his right hand but not with his left showed the power of this approach and launched his career as a behavioral neurologist

GESCHWIND, EVOLUTION

• Revives cortical localization based analysis of human behavior and behavioral disorders

• Brings study of human behavior back into the framework of neurology and away from the purely behavioral analysis of the earlier 20th century

• Helps pave the way to what is now the domain of cognitive neuroscience

GESCHWIND, LEGACY

• French neurologist Marc Dax (1771–1837) has also been credited for discovering the link between neurological damage to the left hemisphere, right-sided hemiplegia, and aphasia.

• His discovery, based on three Montpellier cases was submitted to the French Academy of Sciences and published in 1836, TWENTY FIVE YEARS before Paul Broca’s

• 2 years after Paul Broca's Société presentation (1863), Dax’s son Gustave published his own version of his father's work, supported by 140 additional cases he himself oversaw

• Gustave’s work preceded Meynert, Schmidt, and Wernicke in suggesting that the left temporal lobe may be especially important for speech but it was not well received by the scientific community

was not well received by the scientific community

CLOSE BUT NO CIGAR





Nina F. Dronkers, PhD.

Director,Center for Aphasia & Related DisordersResearch Career Scientist

Veterans Administration Northern California Health Care SystemMartinez , CA

A DEEPER LOOK AT PAUL BROCA’S HISTORIC CASES

N. F. Dronkers, O. Plaisant, M. T. Iba-Zizen and E. A. Cabanis (2007)

Given the great significance of Broca’s patients Dr. Dronkers sought to re-examine the specimens to accurately establish the full extent and location of previously identified lesions identify additional important features if any

To achieve these objectives in a non-destructive manner she employed high-resolution MRI technology

Doctor Dronkers’ team examined existing scans of the Lelong specimen and scans of the Leborgne specimen, which she had to produced on her own initiative …

BROCA: A SECOND, DEEPER LOOK

MONSIEUR TAN'S BRAIN

Currently in display at the Dupuytren Museum

in Paris

(but temporarily taxied around Paris’ notoriously dangerous streets

for a more in-depth look)

NeuroradiologicalImages of Lelong's brain

Samples of the first images collected

(1978–1979)

© The Au thor (2007) Pub l i shed by Ox ford Un ive rs i t y P ress on beha l f o f t he Guarantors o f B ra in . A l l r i gh ts reserved. F or Perm iss ions , p lease emai l : j ou rna l s .perm iss ions@ox ford jou rna ls .org

N. F. Dronkers et al. Brain 2007; 130:1432-1441

NeuroradiologicalImages of Leborgne's brain

Upper rowComplete specimen with schematic lines indicating view scanned during session

Lower rowsConsecutive resulting takes

© The Au thor (2007) Pub l i shed by Ox ford Un ive rs i t y P ress on beha l f o f t he Guarantors o f B ra in . A l l r i gh ts reserved. F or Perm iss ions , p lease emai l : j ou rna l s .perm iss ions@ox ford jou rna ls .org

The team found both patients’ lesions extending significantly into medial regions of the brain and way beyond Broca’s original estimations

The team also identified inconsistencies between the area originally identified by Broca and what is now called Broca’s area, a finding with significant ramifications for both lesion and functional neuroimaging studies of this well-known brain area

BROCA: A SECOND, DEEPER LOOKMAJOR FINDINGS







• Dr. Dronkers' research and clinical interests have focused on understanding the speech, language, and cognitive disorders that occur after brain injury

• She and her colleagues have worked extensively with aphasia patients to understand the relationship between areas of the brain affected by injury, and the speech and language disorders that ensue

• Using novel methodologies, Dr. Dronkers and her colleagues have isolated numerous brain regions that play critical roles in the processing of speech and language, and investigated how these relate to other cognitive skills

• Her latest work involves analyzing the structural and functional connections that contribute to language and cognitive processing through advanced work with diffusion and resting state functional neuroimaging

Three-dimensional MRI reconstruction of the lateral left hemisphere of a normal in vivo brain.

N. F. Dronkers et al. Brain 2007;130:1432-1441

© The Author (2007). Published by Oxford University Press on behalf of the Guarantors of Brain. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

BROCA’S AREA: FINAL LOCATION

• Appointed Senator-for-Life

• Member of the Academie Française

• Honorary degrees from learned institutions in France and abroad

• Dies suddenly at age 56

• His two sons become distinguished professors of medical science.

BROCA: LATE LIFE

• Le Figaro, who like the Journal des Connaissances Medicales and Le Temps, knew every detail (some contradictory) added that “according to all probability, Dr. Paul Broca has succumbed to a bulbar hemorrhage, caused by excessive work….”

• Le Temps had him die of an aneurysm, the subject of his 1856 book

• Paul Reclus and Samuel Pozzi who along with two other doctors undertook the autopsy, spoke of an attack of angina, yet “the heart was sound, the brain intact, the viscera normal” they also noted

• No post-mortem protocol was left

• Chudzinski made a cast of the brain

BROCA: POST-MORTEM CONTROVERSY

KARL WERNICKE

1848Prussia

1905Grafenroda, Germany

57 Years

WERNICKE: RELEVANCE

• Most important figure in 19 th century aphasiology

• Studied neuroanatomy with Meinert in Vienna

• Published most major paper in 1874 (at age 26)

• Generally supported Broca

• Identified “Broca’s aphasia” as difficulty with speech production

• Identified a posterior language center responsible for speech comprehension, now known as Wernicke’s Area

• First researcher to model language processes in the brain

• Located in posterior superior temporal lobe• Essential for speech comprehension• Locus of auditory images of words• If damaged:

– comprehension impaired– speech is fluent– Patient is unaware of his errors

WERNICKE’S AREA

• Proposed a theory (with Lichtheim) in 1874 involving function localization but in a more operationally precise manner than its predecessors

• Accepted Meinert’s postulation of a fiber bundle connecting the two basic language areas – arcuate fasciculus

WERNICKE: CONNECTIONISM

WERNICKE: CONNECTIONISM AND THE ARCUATE FASCICULUS

• Learned about it from Meinert in Vienna

• Predicted “Conduction Aphasia”

– Would result from damage to this bundle

– Such a patient would be unable to transmit auditory identification to speech production area, hence, impaired repetition

– Later, met a patient with just this problem

Arcuate Fasciculus

FINAL THOUGHTS Broca and Wernicke’s contributions were controversial but they

also became the foundation for the understanding of the neural basis of language and continued to be pursued actively

The brain bases of language are still being clarified

Early work from the 19 th century scientists have formed models for brain bases for speech production and perception that are still relevant today

Language systems involve large interconnected networks that are in constant contact with long-term memory stores and abstract conceptual representations.

FINAL THOUGHTS

Broca and Wernicke’s contributions faded away for almost a century

Geschwin brought most of these contributions back and revalidated them

Current imaging techniques are investigating the relationship between these large scale neural networks in the brain