Broca’s faculté du langage articulé: Language or Praxis?

De Oliveira-Souza, Moll, and Tovar-Moll (this issue) historically reevaluate that Paul Broca’s aphemia should be considered as a kind of apraxia rather than aphasia. I argue that such a claim is unwarranted, given the interpretation of the faculty of speech Broca derived from his predecessors, Jean-Baptiste Bouillaud and Franz Joseph Gall, and also with a view on the then generally held opinion that the terms aphémie and aphasie were synonyms. I will discuss evidence that patients such as Leborgne, producing only very few words or syllables, suffer from a global aphasia, affecting all modalities, despite Broca’s statement that Leborgne’s comprehension was intact. I also point to Broca’s claim that the faculty of speech, located in the left anterior hemisphere, is independent from hand preference because it is an intellectual and not a motor function, and to his statement that the cerebral convolutions are not motor organs. I finally contend that, in order to determine whether a given language problem should be labeled as aphasia or apraxia, it is crucial to first be clear on the components of old and new models of language production.     

Broca and Charcot’s Research on Jacques Inaudi:The Psychological and Anthropological Study of a Mental Calculator

In the nineteenth century, French scientific institutions became interested in young “mental calculators,” arithmetical prodigies able to quickly and accurately perform complex mental calculations. The first scientists to study mental calculators were phrenologists who sought to prove the existence of a calculating organ in the frontal lobe. Paul Broca introduced one such mental calculator, Jacques Inaudi, to the Anthropological Society of Paris in 1880. Broca attributed extraordinary faculty for mental calculation to memory functioning (the psychological hypothesis) rather than physiological difference (the phrenological hypothesis). In 1892, prominent French Academy of Sciences member Jean-Martin Charcot produced a noteworthy study of Inaudi on the organization’s behalf. Charcot observed that Inaudi called upon auditory memory rather than visual memory in his mental calculations, unlike most mental calculators who preceded him. Like Broca, Charcot was skeptical of the phrenological hypothesis, though he noted that Inaudi’s skull was markedly plagiocephalic. Interestingly, anthropological examination of Inaudi is consistent with the themes of modern cognitive neuroscience. Thus, Charcot seems to have anticipated present research on the localization of mental calculation and memory for numbers.     

Brown-Séquard and cerebral localization as illustrated by his ideas on aphasia

Brown-Séquard's concept of localization was built on the phenomena of inhibition and dynamogenesis, constituting a dynamic system in which reflex mechanisms, that played a part not only in the spinal cord but in the brain as well, were considered of particular importance. The use of this concept is considered in Brown-Séquard's discussion of the subject of cerebral localization, and especially of aphasia. The origin and development of Brown-Séquard's ideas on aphasia from 1861 onwards are discussed, as is the part he possibly played in the transfer of knowledge from Paris to London (Broca and Jackson). In the 1870's Brown-Séquard debated on cerebral localization with Charcot before the Société de Biologie. Opposing the cluster theory of localization, Brown-Séquard developed the theory of "réseau de cellules anastomosées", a kind of network theory in which scattered cells subserving the same function are connected by nerve fibers. This was to him a plausible theory, with which he was able to explain the fact that damage in several locations may produce the same effect, and, to account for observations that some functions remain unimpaired despite extensive brain-injury. Although Brown-Séquard's arguments were not always valid, because they were based on imprecise observations, his dynamic model, nowadays, seems valuable. He influenced "anti-localizers" such as Goltz, but also Jackson and probably Von Monakow and Sherrington.     

Broca’s Aphemia: The Tortuous Story of a Nonaphasic Nonparalytic Disorder of Speech

Broca coined the neologism “aphemia” to describe a syndrome consisting of a loss of the ability to speak without impairment of language and paralysis of the faciolingual territories in actions unrelated to speech, such as protruding the tongue or pursing the lips. Upon examining the brains of patients with aphemia, Broca concluded that the minimum possible lesion responsible for aphemia localized to the posterior left inferior frontal gyrus and lower portion of the middle frontal gyrus. A review of Broca’s writings led us to conclude that (a) Broca localized speech, not language, to the left hemisphere, (b) Broca’s aphemia is a form of apraxia, (c) Broca’s aphemia is not, therefore, a terminological forerunner of aphasia, and (d) Broca was an outspoken equipotentialist concerning the cerebral localization of language. Broca’s claim about the role of the left hemisphere in the organization of speech places him as the legitimate forebear of the two most outstanding achievements of Liepmann’s work, namely, the concepts of apraxia and of a left hemisphere specialization for action.     

Authors’ Response

Broca’s first patient presented in support of a relationship between a lesion of the frontal lobe and aphasia was patient Tan. Although Pierre Marie refers to this case as “indisputably aphasia of Broca,’” the clinical diagnosis of Tan’s aphasia has not been re-examined in light of current clinical criteria. Superficially, the patient’s extremely limited verbal output and intact comprehension appear to fit with the diagnosis of Broca’s aphasia, but a more thorough examination of the onset, evolution and nature of the patient’s speech symptoms suggests alternate interpretations. Contemporary evidence in support of a robust relationship between stereotypical utterances and Global aphasia suggests that patient Tan may have suffered from a Global rather than Broca’s aphasia.     

Charcot and aphasia

Whereas the beginning part of Charcot's career was occupied with a rigorous and unerring devotion to the anatomo-clinical method, his later career shared attention with physiologic and psychological analyses of hysteria. The seeming paradox between these differing approaches to neurologic study can be better understood by an analysis of Charcot's work on aphasia. This area of study grew out of Charcot's larger research effort on cerebral localization, but was not well known, because most of his lectures on aphasia were never widely published or distributed in either French or English. In analyzing aphasia, Charcot began with anatomic lesions, but gradually incorporated cases of hysterical aphasia, as evidence of dynamic lesions of the same brain areas. Although aphasia never represented a prominent area of study for Charcot, it held a particularly important place in his career first because it provided this transition between anatomic and physiologic approaches to neurologic research, and second because it permitted a natural two-way passage between the topics of cerebral localization and hysteria.     

Cortical epileptogenesis and David Ferrier

There was an increasing medical interest in the localization of representation of function in the cerebral cortex after Broca in 1861 identified a cortical area that appeared responsible for expressive speech. By the late 1860s, John Hughlings Jackson—based on clinico-pathological correlations mainly in persons with focal motor seizures—had reasoned that contralateral somatic motor function was represented in another area of the cortex. This localization was supported by Fritsch and Hitzig (1870) in experimental cortical stimulation studies in dogs. These authors also reported producing events resembling contralateral motor convulsing in their animals. Their work, and Jackson’s ideas, prompted David Ferrier, in Great Britain, to begin a program of cerebral cortical stimulation studies in various vertebrate species, trying to locate cortical sites of representation of functions other than expressive speech and motor activity. In his initial report of his investigations (1873), he noted that appropriately sited Faradic stimulation evoked immediate or delayed contralateral focal motor seizures, some of which evolved into generalized convulsions. On this basis he reasoned that focal motor and generalized seizures were expressions of the same disorder; that nearly all epilepsies originated in the cerebral cortex and not in the lower brain stem, as hitherto thought; and that the clinical pattern of epileptic seizure phenomenology depended on the function of the cortical site of origin and the extent and direction of spread of seizure activity in the brain. He not only provided experimental verification for Jackson’s reasoning about epileptic seizure mechanisms but expressed the ideas a good deal more clearly than Jackson ever managed to do. Ferrier’s achievement in this regard has tended to escape notice, lost sight of because of the great importance of his investigations into localization of cerebral function.     

Patient Tan revisited: a case of atypical global aphasia?

Broca's first patient presented in support of a relationship between a lesion of the frontal lobe and aphasia was patient Tan. Although Pierre Marie refers to this case as "indisputably aphasia of Broca," the clinical diagnosis of Tan's aphasia has not been re-examined in light of current clinical criteria. Superficially, the patient's extremely limited verbal output and intact comprehension appear to fit with the diagnosis of Broca's aphasia, but a more thorough examination of the onset, evolution and nature of the patient's speech symptoms suggests alternate interpretations. Contemporary evidence in support of a robust relationship between stereotypical utterances and Global aphasia suggests that patient Tan may have suffered from a Global rather than Broca's aphasia.     

APHASIA,HISTORY, AND DURESS

This essay celebrates the publication of Duress, explores its concepts and themes, focuses on the way Ann Stoler rejects the notion of historical forgetting and develops a heuristic of “colonial aphasia” in an ethnographic chapter on the emergence of France's Far Right near Marseille in the 1990s. The essay also tracks how postcolonial scholars are using the notion of aphasia, drawing on Stoler's colonial usages in contexts like the Netherlands and Britain as well as using the notion to periodize. Those who came to aphasia before and without Stoler are also present here, and their contributions suggest a range of ways to think through radical, countercultural, and philosophical thought. That Gilles Deleuze and Paolo Virno use aphasia in contrary ways suggests that once aphasia departs from clinical settings, its poetics are rather up for grabs even if contained within activist gestures; both rethink matters of politics, dissent, and language. The example of Kurt Goldstein is also imported to show that clinical aphasia may go with the “detours” of patients, those stricken by war, catastrophe, and these peculiar speech disorders. That “detour” is also a Deleuzian word opens wide a “minor” register to history, speech, and forms of oppression. The semantic spectrum for aphasia in histories of politics and language is wide, from Stoler's colonial version that applies most to the privileged, to Deleuze's poetic transpositions that propose aphasia as an accomplishment, a rebellious refusal of communication. Aphasia has much promise as a historical category in and outside of colonial forms of duress.     

The development and evolution of “cerebral thermometry”: Clinical applications of a nineteenth-century approach to cerebral localization and neurological diagnosis

ABSTRACT

Surface thermometers were developed in the latter half of the nineteenth century. In 1877, Broca, already famous for his contributions to the cerebral localization of nonfluent aphasia, presented his first clinical observations on cranial surface temperatures: In two cases, cranial surface temperatures were decreased over a middle cerebral artery infarction, and increased in surrounding areas, which Broca attributed to “compensatory hyperaemia.” As Broca made apparent in a later report in 1879, he had used a “thermometric crown,” an apparatus consisting of six to eight large-reservoir mercury thermometers strapped against the head. Following Broca’s report, American neurologists reported cases in which cranial surface temperatures were increased either locally over a superficial brain tumor or globally with a cerebral abscess. Despite promising anecdotal reports, contemporaries recognized that significant technical and practical problems limited its accuracy, reliability, and clinical utility. Advocates never demonstrated that this technology provided significant marginal benefit to the medical history and physical examination. The technique fell out of fashion before 1900, though some early advocates promoted it into the early twentieth century. It was ultimately replaced by more effective technologies for cerebral localization and neurological diagnosis.     

A reappraisal of the controversy of Dax and Broca

Paul Broca is unanimously recognized as the founder of neuropsychology. Helis development of the scientific method to map mental functions onto brain topographpy has been enormously influential. Nevertheless, Dax's paper on the left hemisphere dominance for speech was written and published before Broca explicitely proposed the same theory. Probably, Broca was aware of the paper prior to 1865, but he never acknowledged Dax's original theoretical contribution. On the contrary, he always claimed to be the first to espouse the theory of left hemisphere dominance for language and never quoted Marc Dax (Broca, 1877 p 536), 'I do not like dealing with the questions of priority concerning myself. That is the reason why I did not mention the name of Dax in my paper'. In our opinion, the weight of evidence reported here suggests that the theory of the left hemisphere dominance for speech must be attributed equally to Dax and Broca, and henceforth should be called 'the theory of Dax-Broca'.     

White matter—Maximien Parchappe and the integration of articulate language

ABSTRACT

The Imperial Academy of Medicine of Paris met in the spring of 1865 to discuss the localization of speech. One of the participants was Maximien Parchappe (1800–1866), an alienist whose research interests lay in the cerebral cortex. This article addresses Maximien Parchappe’s concept that the cognitive elements of language—such as the translation of thoughts into words, the will to express them, and the means to do so—reside within the cortical gray matter, and that they are integrated through white-matter fibers. In so doing, Parchappe anticipated Carl Wernicke’s linking of the posterior aspects of the dominant frontal and temporal lobes in verbal expression, and Jules Dejerine’s linking of the angular gyrus and Wernicke’s area in the understanding of written language. Functional imaging has revived interest in language as a network of neuronal aggregates and has given new relevance to Parchappe’s concept of the functional organization of language.     

William Rutherford Sanders (1828–1881) and his neurologically fertile years (1865–1868)

ABSTRACT

William Rutherford Sanders (1828–1881) was an Edinburgh physician who occupied the Chair of Pathology at the University of Edinburgh from 1869 to 1881. All of his published output between 1865 and 1868 was concerned with neurology. In arguing that a patient did not have paralysis agitans, Sanders (1865) employed the term “Parkinson’s disease” for the first time in the English-language literature to distinguish between the disorder that Parkinson (1817) termed “paralysis agitans” and other types of shaking palsies. He contributed a major chapter on the same topic to Russell Reynolds’s A System of Medicine (1868). Sanders also investigated the innervation of the palate and facial muscles (1865), and in 1866 recorded the autopsy findings in two cases of aphasia. Here, for the first time in the English-language literature, he described findings that supported Broca’s location of the representation of speech to a particular area of the left cerebral hemisphere.     

The Discovery of Motor Cortex and its Background

In 1870 Gustav Fritsch and Edvard Hitzig showed that electrical stimulation of the cerebral cortex of a dog produced movements. This was a crucial event in the development of modern neuroscience because it was the first good experimental evidence for a) cerebral cortex involvement in motor function, b) the electrical excitability of the cortex, c) topographic representation in the brain, and d) localization of function in different regions of the cerebral cortex. This paper discusses their experiment and some developments in the previous two centuries that led to it including the ideas of Thomas Willis and Emanuel Swedenborg, the widespread interest in electricity and the localizations of function of Franz Joseph Gall, John Hughlings Jackson, and Paul Broca. We also consider the subsequent study of the motor cortex by David Ferrier and others.     

Localization of Language Function in the Twentieth Century

In the twentieth century the method of identifying pathology in patients with aphasia has fluctuated between localizing and holistic theories. The practical localization of sensation and voluntary movement became a clinical commonplace in the beginning of the century, but the mental component of aphasia made its localization controversial. In Paris before the war, Pierre Marie made the localization of aphasia the centerpiece of his personal feud with Jules Dejerine. After the war Konstantin von Monakow used the phenomenon of recovery from aphasia to support his holistic views of localization. Henry Head, in a 1926 study that remains influential today, took a neo-Jacksonian approach to localization and the physiology of language. Kurt Goldstein led the postwar anti-localizationists, asserting that physicians must look after the whole person and that brain function was inherently unified. Norman Geschwind reflected 1960s physiological thought in analyzing aphasia as a type of disconnection of distinct functional areas. In the twenty-first century the localization of aphasia remains dependent on theory, with competition between holistic and localizing ideas.     

The discovery of motor cortex and its background

In 1870 Gustav Fritsch and Edvard Hitzig showed that electrical stimulation of the cerebral cortex of a dog produced movements. This was a crucial event in the development of modern neuroscience because it was the first good experimental evidence for a) cerebral cortex involvement in motor function, b) the electrical excitability of the cortex, c) topographic representation in the brain, and d) localization of function in different regions of the cerebral cortex. This paper discusses their experiment and some developments in the previous two centuries that led to it including the ideas of Thomas Willis and Emanuel Swedenborg, the widespread interest in electricity and the localizations of function of Franz Joseph Gall, John Hughlings Jackson, and Paul Broca. We also consider the subsequent study of the motor cortex by David Ferrier and others.     

Post Scriptum to the Biography of Monsieur Leborgne

In 1861, Paul Broca presented a case of a patient who had almost completely lost the ability of speech production. This patient is known as “Monsieur Leborgne” alias “Tan.” In describing the history of his disease, Broca reported that Leborgne had spent a total of 21 years in hospitals. The article features new information on the history of Leborgne's hospitalization.     

Gustave Dax and his fight for recognition: an overlooked chapter in the early history of cerebral dominance

The year 1865 was revolutionary in neuroscience. In this year, three papers were published on the topic of cerebral dominance for speech. These papers were authored by Paul Broca, Marc Dax, and Gustave Dax, and they contributed to a priority debate that cannot be easily resolved. Gustave Dax claimed that his long dead father had written a memoir and presented it orally in Montpellier in 1836, thus making him the first person to write about cerebral dominance. He also claimed that he was the second person to write on the subject, the first to support his father's claims, and the first to try to localize the center for speech in just one part the left hemisphere, the middle (temporal) lobe. Paul Broca, however, was now getting much of the credit for these discoveries. To set the record straight, Gustave published several letters. This paper presents translations of Gustave's letters of 1866, 1875, and 1877, as well as the historical note written by Raymond Caizergues in 1879, and recreates the events that triggered the younger Dax's anger.     

The dhow as cultural icon: heritage and regional identity in the western Indian Ocean

Dhows, the traditional sailing ships of the western Indian Ocean, are currently used in museums, heritage sites and popular culture as a symbol of a regional culture in the western Indian Ocean. While scholars have embraced the notion of seas as cultural or historical units, this type of ‘basin thinking’ is a recent phenomenon in the Indian Ocean. Over the last 150 years the dhow has gone from being a despised symbol of the slave trade and economic underdevelopment to representing a romanticized past and a regional identity. This article traces the parallel development of the idea of the dhow as a symbol of regional identity and changing perceptions of both the vessels and the region it is taken to represent. It argues that recent representations of dhows as cultural heritage represent a new and developing notion of regional identity within the western Indian Ocean.     

Control Over Government: Institutional Isomorphism and Governance Dynamics in German Public Administration

The era of public management change is said to challenge traditional "command and control" modes of governance, encouraging a move toward either more informal forms of (co-) governance or market-type incentives and competition. Regardless of whether these claims are made by reform advocates or by more sceptical observers within the wider governance debate, less attention has been paid by either side on the mechanisms that are supposed to facilitate the spread of new forms of control. This article seeks to advance this state of affairs in two ways. First, it utilizes the notion of institutional isomorphism to explore the nature of change of modes of control. In particular, it assesses the mechanisms for change, whether control mechanisms are changing due to coercive, mimetic, or professional mechanisms. Second, it explores the impact of these mechanisms in the federal context of Germany in two policy domains, prison and local government supervision (in the field of building administration). Finally, this article suggests that cultural theory offers considerable insights for the study of institutional isomorphism by emphasizing conflicting worldviews and the diversity of related policy ideas as driving forces of change in modes of governance.