DISCOVERY
Cerebral Localization of Language from Gall to Broca:
A Detailed Historical Perspective
Serge Nicolas* & Hedvig Söderlund**
* Department of Psychology, Paris Descartes University
Boulogne-Billancourt, France
** Department of Psychology, Uppsala University
Uppsala, Sweden
Abstract
Paul Broca (1824–1880) has long been credited with localizing language in the inferior gyrus of the left frontal lobe; today, damage to this region is often called Broca’s aphasia. However, the relation between the left frontal lobe and the speech function was not discovered by Broca alone. In this paper, we tell the detailed story of how the location of speech was established. Based on the work of his precursors, Franz-Joseph Gall and Jean-Baptiste Bouillaud, the critiques at the Academy of Medicine from scientists such as Jean Cruveilhier, Gabriel Andral, Claude François Lallemand, and Jacques André Rochoux, and the case studies of, for example, Leborgne (Tan) and Lelong, Broca narrowed down the area for speech to the third convolution of the left frontal lobe, which today bears his name.
Key words: language, localization, Broca, Bouillaud, Gall
Introduction
Until the nineteenth century, the majority of French philosophers subordinated thought to speech (cf. Nicolas, 2007), claiming that the former was a consequence of the latter. It was argued that only spoken words could lead to abstract ideas, and that language was paramount in the development of our faculties, our skills, and so on. But pathological physiology would show that the special faculty of spoken language was related to a dynamic act rather than an intellectual one. Therefore, the observations made by some physicians raised a difficult philosophical question: how can intelligence remain intact when speech is lost? Medical observations of this nature had decisive consequences for psychology, and the story of these discoveries will be the focus of this paper.
The main proponent of this intellectual revolution was Paul Broca (1824–1880), although he benefited greatly from the work of his precursors, and in particular Franz-Joseph Gall (1758–1828) and Jean-Baptiste Bouillaud (1796–1881). We are aware of Schiller’s (1993) work in this area, more specifically Chapter 10 “A manner of not speaking,” a beautifully detailed account of the science of the clinicopathology of the motor speech component of human language in the first 60 years or so of the nineteenth century. But Schiller did not present a detailed account of some of the early reports from the medical community in France, which present pre-1860 arguments, theories, hypotheses, etc., concerning motor speech irregularities subsequent to nervous system damage. Moreover, any discussion of this period in the history of neuroscience must invoke Xavier Bichat (1771–1802) and his so-called “law of symmetry,” since Broca was the first scientist to show that the manifestation of language depends on the integrity of a particular brain region in the left hemisphere. The notion of lateralization developed from this initial localization of speech, constituting a revolution in physiology as well as in psychology.
Gall’s Phrenology and Localization of Language
Franz-Joseph Gall was the first scientist to hypothesize that language might be localized in a specific area. Gall first briefly presented his main ideas in 1798 (Gall, 1798), and then in various important pieces of work between 1810 and 1825 (Gall, 1818, 1819, 1822a, 1822b, 1823a, 1823b, 1823c, 1825; Gall & Spurzheim, 1810, 1812). According to Gall (1) faculties and propensities were innate in humans and animals; (2) human faculties and skills were located in the brain; (3) faculties were not only separate and independent from skills, but different faculties and skills were themselves separate and independent from each other; (4) the organs’ differentiated distribution and their differentiated development resulted in different shapes of the brain; (5) the assembly and development of a particular organ resulted in a particular shape, either of the brain, its parts, or its smaller regions; and (6) from the time of the formation of the skull up to old age, the conformation of the internal surface of the cranium depended on the external conformation of the brain. One could therefore be sure of certain faculties and skills, as long as the skull’s external surface matched its internal surface, or as long as the form of the skull did not diverge from known deviations. Accordingly, the bones of the cranial vault develop as a function of the cortical part they cover, so that a bony prominence conceals a developed cortical sector, and vice versa. Palpating the cranium is almost equivalent to examining the cortex; this is the definition of “cranioscopy,” which phrenology was later erroneously reduced to (these two terms were never employed by Gall). Gall claimed the existence of at least 27 fundamental and innate faculties, in addition to determining the exact cerebral structures for the majority of them, located bilaterally symmetrically in both hemispheres in line with the “laws” of the day (Bichat, 1802). In his influential book, Bichat stated that men and animals were symmetrical entities, on the outside and the inside. Thus, both hemispheres served the “faculties” in mostly homologous regions, which can be seen on phrenological skull charts.
Gall dedicated a particular structure in the anterior part of the brain to what he called the sense for words, sense for names, memory for words, verbal memory (faculty no. 14). He formally distinguished this structure from the sense for language and speech (faculty no. 15), as well as from those structures associated with things and facts, localities, persons, color relations, tone relations, number relations, etc.
Most of the medial portion of the inferior anterior convolution, located on the superior side of the orbit or on the vault, is very developed. This wall is not only flattened, it is depressed, which results in a particular positioning of the eyes. In this case, the eyes are bulging and depressed towards the cheeks at the same time, so that there is some space between the bulb and the upper arch. When the bulb is depressed in this fashion, it exerts pressure on the lower arch and increases the indentation. In a living subject whose eyes are open, this strong indentation gives rise to the appearance of a small water-filled bag, which is where the expression “bags under the eyes” comes from. People with eyes like this not only have an excellent memory for words, but are also particularly gifted in the study of languages, criticism, and all that relates to literature in general.[1] (Gall, 1819, vol. IV, p. 79)
Gall cited a number of famous men known for their language skills, all of whom had large, depressed eyes.
To further support his claim, he then reported two observations, the first of which was taken from the work of Philippe Pinel (1745–1826) on mental alienation, and the second from Baron Dominique Jean Larrey (1766–1842). In the latter case, Larrey had sent Gall a soldier for observation, who after suffering an apoplexy attack, could no longer express his feelings or thoughts through speech. His face showed no signs of intellectual disturbance, his mind found the answers to the questions he was asked, and he did everything he was asked to do. It was, however, impossible to make him repeat a word on the spot, even though he could involuntarily produce the same word just a few minutes later. Feeling embarrassed about his lack of spontaneous production, he pointed at the lower part of his forehead as if to show that that was where his inability to speak originated. On the basis of this observation, Gall deduced that it was only the faculty of speech that was destroyed in this individual. Even though this case was indisputable evidence supporting the existence of a particular sense for spoken language, it did not reveal anything about which brain area was affected.
Gall’s work has been examined in vain for a clear distinction between the sense for words and the sense for speech. It is therefore no surprise that Gall later considered the sense for words to be nothing more than a part of the sense for spoken language (Gall, 1823c, vol. V, p. 18). There is no mention in Gall’s work of this major issue, which is that the global faculty of speech is made up of two elements or factors that are totally separate. One is mental and is related to words, names, and signs in general, which must be formed, invented or learned, understood and remembered. The other is related to the movements necessary to express, pronounce and articulate these words. These movements must be formed, learned and remembered, just like the words per se. Gall did not gather a sufficient number of clinical observations to show that the senses in question were indeed located in the areas of the anterior lobes he had suggested. Furthermore, he had not even considered that cases of speech loss could be divided into two broad categories: one in which the loss of speech derives from an alteration of the brain areas involved in the sense for words, and another in which the loss derives from an alteration of the brain areas involved in coordinating the movements that give rise to the pronunciation and articulation of words. Gall (1823c, vol. V, p. 13) also concluded his treatise on the sense for words, the sense for names, the memory for words, and verbal memory, with the following thought: “It is no doubt very odd that it is precisely on the topic of this faculty that my work is most incomplete.”
Localization of Language by One of Gall’s Admirers: J. B. Bouillaud
Jean-Baptiste Bouillaud (1796–1881) was a disciple of the theory of multiple cerebral organs (structures) who was active in the 1820s, although he was somewhat critical of Gall’s phrenology, whose methodology he thought needed improving: “We hardly have anything but conjectures on the relations existing between certain mental functions and certain cerebral areas. Accordingly, in his Précis de physiologie expérimentale, our most famous physiologist [Magendie] rightly calls phrenology a pseudoscience, as astrology was not long ago.” To develop this “pseudoscience” (cf. Bouillaud, 1865a, p. 588), Bouillaud started to search for a new (anatomo-clinical) method to support Gall’s cerebral theory (phrenology or science of the mind), or, as he put it himself, Gall’s psychology (Bouillaud, 1865a, p. 586). This would also undermine the theories of Flourens (1824, 1842) according to which all parts of the cerebral lobes perform almost identical functions (see Nicolas, 2009).
The Anterior Lobes of the Brain: Site of the Speech Organ (1825)
The special purpose of the thesis that Bouillaud presented at the Royal Academy of Medicine on February 21, 1825, was to determine the brain’s impact on the coordinated movements that produce speech. The title of the thesis alone was telling in its explicit support of Gall’s work: “Clinical research likely to demonstrate that the loss of speech corresponds to a lesion of the anterior lobes of the brain, and to confirm Mr. Gall’s opinion on the site of the speech organ” (Bouillaud, 1825a, also published in the Traité de l’encéphalite, Bouillaud, 1825b).
The purpose of the paper was to demonstrate the existence of a special cerebral center devoted to the control of speech movements; in it, Bouillaud also suggested what method should be used to identify the region responsible for speech control. Specifically, since experimental brain lesions cannot be induced in humans, the only solution was to examine the correlation between anatomy and function in brain lesion patients. This method should enable speech to be localized in the brain; Bouillaud (on the basis of Gall’s work) placed it in the anterior (frontal) lobes. If speech movements originate in the frontal lobes, then this should be reflected in two kinds of clinical observations: (1) when the anterior lobes are affected, speech should be affected; (2) when the anterior lobes are intact, speech should not be affected. Following this principle, Bouillaud described some cases where the anatomo-clinical correlations corresponded to his expectations. The following conclusions were drawn: (1) the coordinated movements of speech are controlled by a particular cerebral center; 2) this center, which in some ways is the governor of these movements, resides in the anterior lobes of the brain; (3) speech loss in general is due to the loss of coordinated movements of the organs involved in the pronunciation and articulation of words, but can also be due to the loss of the memory of these words; (4) the nerves activating the muscles underlying the articulation of words originate in the anterior lobes of the brain, or rather there is a necessary communication with these lobes. In this way, complicated movements underlying the articulation of sounds arise from the anterior lobes. Thus, Bouillaud refined the phrenological model and used his collection of cases to justify frontal lobe/anterior locations for motor speech.
Gall, who had lived in Paris since 1807, certainly heard of Bouillaud’s initial discoveries that favored his phrenological thesis. When Gall died in 1828, Bouillaud continued doing research from Gall’s perspective although he remained critical of Gall’s phrenology. Nevertheless, in the following years, Bouillaud was one of the main proponents of the French phrenology movement which acquired a new reputation as such individuals as F. Broussais and Auguste Comte took up Gall’s legacy. When the Société phrénologique de Paris was created on January 14, 1831, Bouillaud was one of the titular members. The society’s first annual session was held at the City Hall of Paris (Hôtel de Ville) under the presidency of Matthias Dannecy on the anniversary of Gall’s death, August 22, 1831. The contributions to this memorable session were collected in the society’s brand-new journal, for which Bouillaud was the chief editor and wrote the prospectus (Bouillaud, 1832). In it, he emphasized that Gall was the immortal creator of the phrenological doctrine, which should be expounded to the best of their ability.
The time has finally come when Gall’s system, which is well understood and philosophically developed, should create a revolution in the intellectual and moral world, comparable to the one Newton imposed on the physical world. In the same way that English geometry dissects light by using the prism and compass, and calculates the laws that govern celestial bodies, Gall, with the prism of his profoundly observant genius and gifted with a patience matched only by his genius, decomposes and analyzes something far more subtle than light – the mind, intelligence, understanding, in one word, the moral element of mankind. (Bouillaud, 1832, pp. 6–7)
First Critiques of the Anatomical Localization of Language by the Academy of Medicine (1839)
The conclusions that Bouillaud announced in 1825 were the subject of lively criticism in the following years by the famous physicians of the day: Jean Cruveilhier (1791–1874), Gabriel Andral (1797–1876), and Claude François Lallemand (1790–1853).
On October 29, 1839, Bouillaud decided to respond to his critics by presenting 13 new cases in a paper at the Academy (Bouillaud, 1839) and by showing how inadequate his adversaries’ descriptions were. Here is the general summary and conclusion of his 1839 paper:
The eighteen observations that were brought against us by Messrs. Cruveilhier, Andral and Lallemand did not quite pass the test we put them through. When examined with new attention, there are even a few that do not contradict but favor our conception. However, we will not use this advantage, and in accordance with sound scientific philosophy, we only demand that these observations or these arguments be put aside and considered as nonexistent. (…) In any case, even though we have admitted this principle that the governing spirit of speech is indeed located in the frontal region of the brain, which is so full of other special faculties, we still do not know everything about this matter. Where indeed is the precise spot and geometrical area where the power described above is located? And if we assume that it is indeed the area that was defined, I would almost say predicted, by the immortal Gall, we now need to delimit a new and precise site for the partial lesions in the brain that correspond to the equally partial lesions of speech. (Bouillaud, 1839, p. 323 and pp. 325–326)
But the criticisms became ever more vigorous and ever more dogmatic, culminating in the November 5 and November 12, 1839, sessions at the Academy of Medicine.
Cruveilhier (1839) was one such opponent; he took the physiological and philosophical perspective of Flourens (see Nicolas, 2009), the most famous of Gall’s critics (see Gall, 1825). He stated in the discussion at the November 5 session that, in contrast to Bouillaud’s ideas, speech loss appears every time there is widespread destruction of the encephalon regardless of the area in which it is observed: the anterior lobes, the posterior lobes, the optic layer, and so on. He concluded his comment by underscoring that (1) it had never been shown that the faculty for pronouncing sounds had a particular locus in the brain; (2) on the contrary, it had been shown that any profound or extended lesion of the encephalic mass resulted in the more or less total incapacity to pronounce sounds; (3) consequently, the claim that there was a multitude of cerebral organs corresponding to the multitude of emotional and intellectual faculties could not be proven by the facts cited to establish a special location for language. But above all, he carried the battle to the phrenological camp.
Does the faculty of language have a site in the brain, and is this site in that organ’s anterior lobes? This is the question that is now being debated in front of the Academy, and this question is one of the most serious ones Its interest goes beyond that of a specific question; we dare not be wrong since the whole of phrenology will be affected by its solution, because if it were proven that one single human emotional or intellectual faculty has a special location in the brain, the phrenologists would be entitled to conclude that all the other faculties also have special locations and would thereby also be entitled to look for them. Phrenology would thereby be justified; the phrenologists would then only have to agree on the essential faculties, and their number, and consequently the number of cerebral organs, which would not be an easy task, but the principle would finally be acknowledged. But if, on the contrary, it were established that it is impossible to localize in the encephalic mass any of the faculties the phrenologists have claimed – they have already been defeated regarding the site they assigned to physical love, and that the one they assigned to the carnivorous instinct – and if they were also defeated in the new entrenchment created with for them with his usual talent by our colleague Mr. Bouillaud, then –Oh! – in that case, this doctrine of multiple cerebral organs corresponding to the multiple essential faculties would be seriously endangered, and I would start to fear for the fate of phrenology. (Cruveilhier, 1839, p. 334)
New Discussion at the Academy of Medicine (1848)
Paradoxically, even though Bouillaud’s research caused worries that phrenology would make a strong comeback at the scientific and institutional level, phrenology had been inexorably declining in France for some time.
Nevertheless, it was during this period that a new discussion on the localization of language took place at the National Academy of Medicine. As a new controversy broke out, in January 1848, Bouillaud started reading a new paper entitled “Clinical research likely to prove that the sense for speech and the coordination of speech movements reside in the anterior lobes of the brain” (Bouillaud, 1848). In this third work, the number of observations gathered from various authors, in various journals, that he had made himself, or that had been sent to him, approached 800. In this new work, he withheld his thesis in full and presented new observations to support his renewed statement that the faculty for language is localized in the anterior lobes of the brain. In the conclusion of the treatise, Bouillaud stressed that
In the case of a total loss or a simple disturbance or deterioration of speech, resulting mainly from an affliction of the brain itself (cerebral lobes or hemispheres), the affliction is situated in the anterior lobes of this organ. Yet, since it has been proven through a sufficient number of carefully observed facts (1) that serious morbid alterations of the anterior lobe of the brain constantly cause a speech deterioration, a deterioration that can lead to a total loss of this great and precious faculty; (2) that alterations affecting the middle and posterior lobes of the brain (while the anterior lobes stay perfectly healthy) do not result per se in any notable speech deterioration; since, let us repeat, these are the facts, one can only conclude that the internal or cerebral faculty that controls speech has its locus in the anterior lobes of the brain (in accordance with the facts I have reported, the inferior side and the anterior extremity of the anterior lobes in particular seem to be the site of this admirable faculty). (Bouillaud, 1848, pp. 806–807)
The most ardent adversary of the localization of speech in the anterior lobes was, according to Bouillaud himself (cf. session of January 18, 1848, Bulletin de l’Académie nationale de Médecine, vol. 13, p. 548), the neurologist Jacques André Rochoux (1787–1852). In Rochoux’s view, phrenology was the biggest hoax that the scientific world had been subjected to since Mesmer’s magnetism. During the discussion of Bouillaud’s treatise, Rochoux explicitly claimed that “if the localization of speech in the anterior lobes should happen to be proven true, the same thing could happen to craniology one day” (p. 810). In this way, he defended the idea that the anterior lobes were not involved in speech loss: “at the very most, one could say that this happens more often following lesions of the anterior part of the brain than of other parts of the brain, but I still prefer not to answer this” (p. 811). In Bouillaud’s answer, he emphasized that it was indeed Gall who had put forward the doctrine on the localization of faculties in the brain.
But he did not show it; in a sense, he predicted it, and that is a work of genius. But Gall was not always correct in his predictions, for example regarding the cerebellum. Well, what Gall predicted concerning speech, I think I have proven, by also adding a new element to the question, namely the principle of movement coordination for articulation (…) The facts (…) have given me the same answer, which is that the anterior lobes of the brain govern the execution of speech. (p. 812).
Then he suggested to Rochoux that they should collectively raise the money for a prize: “I therefore offer 500 francs to the person who brings me an example of a profound lesion in the anterior lobes of the brain without a deterioration of speech” (p. 813).[2] This discussion at the Academy caused a tumult in medical spheres, but the question remained unsolved for many years to come.
Paul Broca and the Discovery of the Locus of Aphasia (1861–1865)
In 1861, Bouillaud was 65 years old and had been a professor at a medical clinic at La Charité for 30 years; he had become dean of the faculty some time after the revolution of 1848. His age, his talent, and his academic achievements meant that he was an eminent person. Now a new figure appeared on the scene: Paul Broca (1824–1880), the 37-year-old secretary of the Anthropological Society, who worked at the surgical department at the Bicêtre hospice, and was not yet a professor. Like Bouillaud, Broca thought that the fall of Gall’s cranioscopic system had not destroyed the localization principle.
The Anthropological Society and the Context of the Localization of Speech Discussion
During the December 20, 1860, session at the Anthropological Society of Paris, the physiologist Louis Pierre Gratiolet (1815–1865) presented the skull of a Totonac Indian from the Gulf of Mexico. The parietal lumps of this skull were very prominent, and the forehead was very narrow and low, which resulted in the anterior parts of the cerebral lobes not being particularly developed (Gratiolet, 1860, p. 562). Still, this individual’s cranial capacity was similar to that of a white person, and the rather complex structure of the skull revealed slow ossification, as occurred in the white races. In a later session (February 21, 1861), Gratiolet (1861) mentioned the study of the Totonac skull again and concluded by saying that there is no relationship between the development of intelligence and the encephalic mass. Taking Descartes’s small cranial capacity as an example, he claimed that it is “the form and not the volume that determines the brain’s dignity” (p. 71).
At that time, Bouillaud’s son-in-law, Ernest Auburtin (1825–1895), joined the discussion by stressing the need to examine the various parts of the brain rather than the whole, since “the highest cerebral functions are related to the development of the anterior lobes” (Auburtin, 1861, p. 72). He went on to point out that Gratiolet was much closer to Flourens’ doctrine that all parts of the cerebral lobes perform almost identical functions than to Gall’s claim (p. 79). Like Bouillaud, Auburtin did not believe that the different parts of the cerebral lobes performed the same functions. However, in agreement with Bouillaud’s opponents, Gratiolet emphasized that “the pathological observations have not yet produced any consistent findings” (Gratiolet, 1861, p. 80). Broca did not formally engage in the debate.
The continuation of the discussion on the shape and volume of the brain was put off to the March 21, 1861, session. To answer Gratiolet, Broca now intervened in the discussion. Broca (1861a) attacked two suggestions made by Gratiolet during the preceding sessions: (1) brain volume considered either in individuals or in races has almost no meaning; it is the shape and not the cerebral mass that is related to intelligence; (2) as the organ of thought, the brain is a single element, just like thought itself; the different parts making up the brain do not have different functions corresponding to various faculties of the mind. Broca went on to present his ideas on cerebral localization. Even though he denied any direct and intellectual relationship with phrenology, he acknowledged that Gall had shown the way:
The doctrine on cerebral localization was the natural consequence of the philosophical movement of the eighteenth century, because it was no longer a time when one, without hesitation and in the name of metaphysics, could say that since the soul is simple, the brain must also, in spite of its anatomy, be simple. Everything that touched on the relation between spirit and matter had been questioned, and in the midst of the uncertainty surrounding the solution of this great problem, anatomy and physiology, which until then had remained silent, at last raised their voices. It was Gall who was the author of this kind of scientific reform. He had the incontestable merit of announcing the great principle of cerebral localization, which has been the point of departure for all our century’s discoveries concerning the physiology of the encephalon. (Broca, 1861a, p. 191)
Hence, Broca did not think that the collapse of Gall’s cranioscopic system or phrenology had destroyed the principle of cerebral localization. He then wondered how research on this principle should proceed; he thought that only pathological observations, complemented with autopsy studies, could lead to the discovery of particular localizations, provided that future observers described the diseased convolution using regular anatomical names, rather than the vague indications used to describe lesions in this or that area of the brain in the past. In his view, the highest faculties of intelligence were located in the anterior lobes. And of all faculties, it was for speech was the one where it was easiest to recognize a loss.
Aphasia: The Leborgne (Tan) and Lelong (1861) Cases
A few days later, on April 11, 1861, a 51-year-old man named Leborgne who was incapable of speaking was brought into the surgery department where Broca worked. The autopsy of this patient was to provide crucial evidence on the localization question that was being discussed at the time. Leborgne died a few days later, and Broca (1861b) marked an epoch in the history of cerebral localization when he presented a communication to the Anthropological Society entitled “Loss of speech, chronic softening, and partial destruction of the left anterior lobe of the brain” on April 18, 1861. On this occasion, he presented the brain of Leborgne, who had lost the ability to speak 21 years earlier. He could no longer pronounce more than a single syllable, which he usually repeated twice in a row. No matter what question he was asked, he always answered tan, tan, accompanied by various expressive gestures. Because of this, he was known as Tan throughout the hospice. It should be added that anger increased his vocabulary, adding the curse “God’s holy name.” At autopsy, it was found that the speech loss was caused by a lesion in the frontal lobe. On May 2, 1861, when Broca once more discussed the presentation of Leborgne’s brain (April 18) at the Anthropological Society, he simply said:
I brought this piece relating to a rare and curious case to the Society, and through a bizarre coincidence it was presented at the same time as Messrs. Gratiolet and Auburtin discussed the locus of language. But even though I lean towards Mr. Auburtin’s opinion, I did not have any intention of taking a stand in this debate. The position I maintain is neither in favor of nor against particular localizations; I only wish to state a general principle.
In summary, at this point, Broca was far from having made up his mind on the language localization question. Moreover, this presentation did not instantly achieve the status in psychology it now has. Following this communication, the discussion of the brain’s volume and form continued at the Anthropological Society until June 20, with the intervention, among others, of the “three tenors”: Gratiolet, Broca and Auburtin. Still, there is no mention of Broca’s observation in the discussions published in the Bulletin de la Société d’anthropologie at any point.
The complete publication of the observation, accompanied by new ideas and the appearance of the word aphemia, only occurred later at the Anatomical Society. In the article entitled “Comments on the site of the faculty for speech, followed by an observation of aphemia” published in August 1861 in the Bulletin de la Société anatomique, Broca (1861c) did indeed use the name aphemia for this particular kind of loss of speech which represented neither a destruction of intelligence nor a paralysis of the articulatory muscles. The postmortem examination of the aphemic Tan’s brain allowed Broca to support Bouillaud’s conclusions regarding the role of frontal lesions; in addition, thanks to his anatomical knowledge, he attempted to determine the specific area of this lobe which was the putative site of the faculty of speech. He first stressed that it was the posterior part of the frontal lobe that was mainly altered, whereas the orbital part was intact. Until then, the destruction of this posterior region of the frontal lobe which had been put forward, mainly because of Gall’s ideas. Although Broca was very aware of the importance of his anatomical findings, for the moment he remained cautious. He only considered it very probable that a particular faculty might be localized in a specific lobe. He was very reluctant to allow for laterality because this went against the symmetry claim of Bichat (1802) and the phrenologists. Both hemispheres served the “faculties” in mostly homologous regions, which can be seen on phrenological skull descriptions.
Broca remained cautious when he published the anatomo-clinical case of Lelong that same year in an article entitled: “New observation of aphemia caused by a lesion of the posterior half of the second and third left frontal convolutions,” published in the Bulletins de la Société d’Anatomie (Broca, 1861d). In this article, he shows his surprise:
I will therefore not conceal the fact that I experienced an astonishment close to stupefaction when I discovered that, in my second patient, the lesion was at exactly the same site as in the first one… But I cannot forget that, in several of the published observations (reported previously by various authors), aphemia has occurred with lesions occupying mainly (if not exclusively) the anterior half of the frontal lobes. These observations, which are perfectly compatible with the hypothesis of localization in convolutions, seem very difficult to reconcile with the principle of localization in districts, or in compartments corresponding to invariable points of the cranium. I am therefore inclined to attribute the common site of my two patients’ lesions to pure coincidence. (Broca, 1861d)
Broca seemed obsessed by the memory of Gall’s system; in his opinion, the two cases he observed in 1861 seemed to favor that system. But since his clear-sightedness drew him away from it, his doubts remained and Broca continued to look for support for Bouillaud’s doctrine.
The Third Left Frontal Convolution Is the Almost Constant Site of Speech (1863)
Since the publication of Broca’s reports in 1861, which had attracted the attention of observers interested in the lesions involved in aphemia, a number of autopsies had soon been performed in the Paris hospitals by Charcot, Guller, Marcé and Trousseau. All lesions revealed a common feature in that they extended to the third posterior part of the third frontal convolution. Broca, who examined all these studies, noted with surprise that the lesion was always located in the left hemisphere of the brain. Although this remark, first communicated by Broca at the Biological Society on January 17, 1863, relied on only a few cases, it was confirmed by four new autopsies and by the observation of three living aphemics who had a right-sided hemiplegia, implying a left-sided lesion. During the April 3 session at the Anthropological Society (Broca, 1863b), Broca acknowledged that all eight of the aphasic patients he had observed had a lesion in the left cerebral hemisphere. Still cautious, he again asked for new supporting evidence. When pointing out this consistency, Broca added that counter-evidence was needed to see whether lesions of the third right convolution would also affect speech, before language could be localized in the left hemisphere. Indeed, at the end of his communication during this session, he emphasized that his colleague Charcot was currently gathering data regarding this alternative hypothesis (Broca, 1863c, p. 202).
Three months later, on July 17, 1863, Jean Martin Charcot (1825–1893) did indeed publish a letter to the editor of Gazette Hebdomadaire de Médecine et de Chirurgie (Weekly Gazette of Medicine and Surgery) in which he reported the observation of an aphemic patient without any apparent disturbance of the left third frontal convolution (Charcot, 1863). The left third frontal convolution was relatively spared, but there was a destruction of the exterior parietal convolution, in which the frontal convolution turns into the posterior half of the superior side of the Sylvian fissure. Auburtin (1863b) himself tried to minimize Charcot’s observation, but did not succeed. Shocked by this publication, Broca, whose conviction that the left third frontal convolution was the crucial site was still recent (this was in July 1863), felt shaken and accepted Charcot’s report as contradicting his hypothesis. Recognizing the importance of this observation, he wondered whether he should modify his formulation. He required more documentation since “one negative fact does not destroy a series of positive facts; in pathology, and especially in cerebral pathology, there is hardly any rule without exceptions” (Broca, 1863d, p. 384).
At the end of the first half of 1863, Broca gathered 25 cases of aphemia coinciding with lesions in the left hemisphere, without finding a single case of aphemia coinciding with lesions in the right one. The observation of Jules Parrot (1829–1883), published on July 31, 1863, in the Gazette Hebdomadaire de Médecine et de Chirurgie was one of the major observations that Broca had been asking for. Parrot (1863) did indeed find a lesion of the right third frontal convolution in a patient without aphemia. This new observation established Broca’s conviction for good, as he declared at the Surgical Society on February 24, 1864: “From the results of autopsies, I have been impelled to consider the posterior part of the frontal convolution to be the almost exclusive site of aphemic lesions.” (cited on March 5 in La Lancette Française. Gazette des Hôpitaux Civils et Militaires, 37, p. 107). During this session, Broca also emphasized:
More than twenty observations of aphemia followed by autopsy have been gathered. In all cases, without exception, the lesion was in the left hemisphere, and in all cases, with one exception, the posterior third part of the third frontal convolution was severely damaged. This exceptional case, which until now is unique, was collected by Mr. Charcot. The left third frontal convolution was almost intact, but the exterior parietal convolution with which the frontal convolution continues without interruption and which forms the posterior half of the superior side of the Sylvian fissure was destroyed. To many anatomists, these two convolutions are one, called the enclosed convolution of the Sylvian fissure, or the marginal superior convolution. If Mr. Charcot’s observation was interpreted in this sense, it could easily be reconciled with the others. But other observations are needed before anything certain can be said. (in Duval, 1864, pp. 14–15)
In 1865, Broca had solid grounds for affirming the role of the third frontal convolution and demonstrating the reality of the left hemisphere’s functional preeminence for language. This affirmation took place in the context of the Dax-Broca controversy (discussed below) concerning the localization of aphasia (Critchley, 1964a, 1964b, 1979; Cubelli & Montagna, 1994; Finger & Roe, 1996; Moffie & Schiller, 2000; Roe & Finger, 1996). It was at this time that the term aphasia first appeared in the medical literature. It should be remembered that it was Trousseau (1864) who introduced the word aphasia in his classes on clinical medicine, at the suggestion of Dr. Chrysaphis and the eminent scholar Émile Littré (1801–1881), while he was developing his own theory of language disorders. On this naming issue, Broca (1864), who was attached to the term aphemia, defended it in vain in a letter to Trousseau; the letter contained theoretical questions in addition to philological arguments, concerning for example the true nature of the disorder. Trousseau’s successful attempt was most likely due to his hostility towards and jealousy of Broca.
Cerebral Lateralization of Speech (1865)
G. Dax’s Treatise and L. F. Lélut’s Report
According to Broca himself, it was only at the end of 1864 that “the hypothesis regarding the relation between speech and the left hemisphere of the brain was officially put forward following an autopsy performed on an epileptic woman on November 3, 1864” (discussion at the Société d’Anthropologie de Paris, October 5, 1865, p. 494). Some questions concerning priority were raised the following year. It seemed that Marc Dax (1770–1837), a physician in the south of France, had already presented a communication at the Meridional[3] Congress of Montpellier in July 1836 in which he claimed that the forgetting of “signs of thought” was caused by lesions in the left hemisphere (Dax, 1865). This communication, if it took place, had no impact and was never published, not even in the Medical Revue of Montpellier, where no trace of this article has been found. At this time, as we have seen, physicians and phrenologists (like Broussais) were reluctant to posit laterality because it went against Bichat’s law of symmetry. It was assumed that both hemispheres served the “faculties” in mostly homologous regions.
In any case, on March 24, 1863, Marc Dax’s manuscript entitled “Lesions of the left half of the encephalon coinciding with the forgetting of signs of thought” was transmitted to the Imperial Academy of Medicine by his son, Gustave. In this paper, he introduced and elaborated upon his father’s thesis, introducing new elements. The commission that was charged with reading the dissertation only published it at the end of 1864 (cf. Finger & Roe, 1996). At the December 6, 1864, session at the Academy of Medicine, Louis Francisque Lélut (1804–1877), who had left Paris by then, had his colleague Jules Augustin Béclard (1817–1887) read his short report (two pages) without consulting the other members of the commission (Bouillaud and Béclard). The reading of this report stirred up strong emotions in the assembly.
I regret that the Academy did me the honor and entrusted me with this task, and maybe I should have declined. In the physiological-psychological science that I am working on, there is a mass of things that I do not know or that I doubt, and many points on which I am ready to change or modify my opinion. After thirty or forty years, there are a few on which my opinion, rightly or wrongly, will neither change nor be modified. This is the case, in general, for the relation some people have tried to establish between a particular act and a particular faculty of the mind, and a particular part of the central nervous system. This is the case, in particular, of the assignment some wanted to make of this or that part of this system to the act or the faculty of language and speech. This is neither more nor less than phrenology, and I think that I have dealt with this pseudoscience long enough not to return to it (Qu’est-ce que la phrénologie?[4], Paris, 1836; De l’organe phrénologique de la destruction chez les animaux[5], Paris, 1838). (Lélut, 1864, p. 173).
Although in Lélut’s eyes the localization of speech reflected Gall’s phrenological doctrine (Lélut, 1836, 1858), the hypothesis concerning hemispheric specialization appeared even more ludicrous since he believed that the two cerebral hemispheres work in the same way as the two eyes: they carry out the same functions and the left is neither more nor less likely to be lesioned than the right in speech disorders (i.e., law of symmetry, both hemispheres were assumed to be symmetrical in form and function).
J. B. Bouillaud’s Reaction and Discussions of Aphasia at the Academy of Medicine
Lélut’s report caused a scandal. Bouillaud, whose doctrine was still being assimilated with phrenology, immediately declared that he would discuss Lélut’s proposals at the academic sessions. Bouillaud divided his speech into three parts. In the first, he dealt only with the report. In the second, he presented some general considerations on organology, also called phrenology, which was so strongly attacked by Lélut. The third part was devoted to a close examination of the localization of the sense for speech in the anterior lobes of the brain. The sessions took place (in Lélut’s absence) on April 4 and 11, 1865 (Bouillaud, 1865a). On this occasion, Bouillaud first reminded the audience that a certain kind of general movement had taken place in favor of his doctrine, because of the disorder now called aphemia or aphasia. This movement started (1) after the memorable discussion at the Anthropological Society by Auburtin (1861) and the work published in the Gazette Hebdomadaire (Auburtin, 1863a); (2) especially after Broca’s much-discussed and fruitful conversion “to which, I am happy to say, Dr. Auburtin, my close ally through the double bond of doctrine and family, is not completely foreign” (p. 584); and (3) had continued with Trousseau’s (1864, 1865b) brilliant lessons at the Hôtel-Dieu medical clinic. Bouillaud stressed Dax’s discovery, and another, which was “important in another way is that of Mr. Broca, who has, unwilling to accept our own localization, through a daring sub-localization, placed the faculty of speech in the third convolution of the left frontal lobe” (p. 631). Bouillaud criticized the content of the communication supposedly transmitted by Dax in 1836 by emphasizing the author’s incompetence, pointing out that he was unaware of Gall’s and his own research. Several times, Bouillaud underscored Broca’s debt to Gall, using the texts of his younger colleague as support.
On April 18, 1865, Armand Trousseau (1801–1867), who chaired the medical therapy department at La Charité and acted as eternal adversary, entered the discussion on speech disorders and their relation to brain lesions (Trousseau, 1865b). Like many others, he objected to Bouillaud’s claims. The studies of aphasia had started to reach a wider audience and questions of scientific priority became crucial. During the most intense discussions at the Academy of Medicine, G. Dax, who was seriously hurt by the criticism and the lack of attention to his father’s work, published an article in the Gazette Hebdomadaire de Médecine et de Chirurgie (Dax, 1865) which summarized the text he had submitted to the Academy, but which was now preceded by the original work of his father, M. Dax (see Roe & Finger, 1996).
At the time when the discussion at the Academy of Medicine was taking place, Broca was on a trip to southern France for health reasons. When he had arrived in Montpellier, he read some medical journals and found out about the claim of priority G. Dax had made for his father. Broca searched in vain for M. Dax’s dissertation in Montpellier (Broca, 1877). It was on this date, June 15, 1865, following the discussions at the Academy of Science and the communication of Dax’s work, that Broca submitted his famous article to the Bulletin de la Société d’anthropologie on the localization of the faculty of speech in the left hemisphere of the brain (Broca, 1865b). Broca first examined a question of priority that was raised by the posthumous submission of M. Dax’s paper to the Academy of Medicine. This work, which was presented by his son on the occasion of Broca’s research into the special relations between the faculty of speech and the left hemisphere, had purportedly remained unpublished and unknown since 1835 when it was written. Broca, who was searching for the almost constant site of aphemic lesions in one of the convolutions of the left hemisphere, originally declared that there could not be any absolute functional difference between the two hemispheres. Specifically, he noted that, from childhood on, humans accomplish complex actions by dividing the labor between the two hemispheres.
Conclusion
There is no doubt that Gall was the true initiator and guide of Bouillaud’s research on the localization of speech in the anterior lobes of the brain. It is well known that it was specifically for the localization of language and memory for words that Gall’s system was created. In his atlas, the faculty of language is situated in the convolutions of the inferior side of the brain, in the posterior part of the orbital lobe. Gall’s system was very fashionable in the first quarter of the nineteenth century, in spite of its many opponents (Cuvier, Flourens, Gratiolet, Lélut, Rochoux, etc.), and it retained a certain reputation among scientists. The most laudatory of all the authors from this period was, without any doubt, Bouillaud himself, who did not hesitate to place Gall at the same level as Galilee and Newton. Although the executive center of speech production was located in the anterior lobes, he did not raise the issue of lateralization of language. The situation was very clear until the beginning of 1861; Gall’s still had considerable philosophical influence through Bouillaud’s writing, even though his system had mainly been abandoned.
Broca discovered that the site for speech was limited to the third left frontal convolution. It was only in the 1860s that the relation between language disorders and left-sided lesions was highlighted (although this hemispheric dominance could have been discovered earlier, cf. Benton, 1984; Benton & Joynt, 1960), with the result that Broca’s new doctrine was an unexpected success. Three factors contributed to it (see Hécaen & Dubois, 1969): (1) the speech localization problem was common currency among scientists at the academies and the scientific societies; (2) Bouillaud and his partisans were completely open to new proofs supporting their doctrine, which unexpectedly bolstered it; (3) Broca was popular in the medical world, even though the aristocracy of the profession remained incredulous, doubtful, or even openly hostile towards him. Broca’s ideas were progressive. His contemporaries, including Bouillaud, were reluctant to admit that two halves of the same organ, having the same location, the same organization, and apparently the same detailed structure, had not been assigned the same functions by nature. This was an important exception to the rule of organic duality, which obviously implied functional unity. Broca thus contributed significantly to the concept of lateralization of brain functions, which is a highly relevant topic in cognitive neuroscience today. His theories on aphasia also represented a major breakthrough, and today the most common kind of aphasia is called Broca’s aphasia.
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[1] All translations of nineteenth-century texts are ours.
[2] In 1865, seventeen years after this offer was made, in the context of the work developed by Broca, Bouillaud was still waiting for the observation of a profound lesion of the anterior lobes that did not lead to a speech deficit (Bouillaud, 1865a, p. 623).
[3] Refers to the “Midi,” the south of France.
[4] “What is phrenology?”
[5] “On the phrenological organ of destruction in animals.”