Vol. 13 nº 2 - Apr/May/Jun de 2019
History Note Pages 238 to 243
 

Cerebral localization of higher functions: the period between Thomas Willis and Paul Broca
Localização cerebral de funções superiores: o período entre Thomas Willis e Paul Broca

Authors: Eliasz Engelhardt

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Descriptors: higher nervous function; Willis; Broca; aphemia; speech; language; hemispheric asymmetry.
Descritores:
função nervosa superior; Willis; Broca; afemia; fala; linguagem; assimetria hemisférica.

ABSTRACT:
The age-old debates about the localization of the mind (higher functions) took a new course when Willis located a higher nervous function (memory) in the brain parenchyma, and supposedly, in the cerebral cortex. About two centuries later, Broca, founded on solid scientific reasoning, localized a circumscribed area of the 3rd frontal circumvolution of the left hemisphere as the seat of articulate language, a higher function (speech - language domain). He (and Dax) also defined the functional asymmetry (specialization) of the hemispheres, with left dominance (for language). The period between the findings of these individuals was not quiescent, as numerous authors contributed with their theoretical and clinicopathological research toward creating a conducive scientific atmosphere for this accomplishment, and should be regarded as important. Further studies, in the decades that followed, revealed the localization of additional aspects of language and of other higher functions (cognitive domains).

RESUMO:
Os debates milenares sobre a localização da mente (funções superiores) chegaram a um novo caminho quando Willis localizou uma função nervosa superior (memória) no parênquima cerebral, e supostamente, no córtex cerebral. Cerca de dois séculos depois, Broca, baseado em sólido pensamento científico, localizou uma área circunscrita da 3a circunvolução frontal do hemisfério esquerdo como o sítio da linguagem articulada, uma função superior (fala - domínio da linguagem). Ele (e Dax) também definiu a assimetria funcional (especialização) dos hemisférios, com dominância esquerda (para linguagem). O período entre os achados dessas duas personalidades não ficou quiescente, considerando que numerosos autores contribuíram, com suas pesquisas teóricas e clinicopatológicas, para criar uma atmosfera científica adequada para tal realização, devendo ser vistos como importantes. Mais estudos, nas décadas seguintes, revelaram a localização de aspectos adicionais da linguagem e de outras funções superiores (domínios cognitivos).

The localization of the mind (higher nervous functions, faculties) has been a focus of discussion since ancient times. After millennia of religious, philosophical, and scientific thinking, studies and speculations, the brain finally predominated over the heart as the seat of control. Following a hypothetical ventricular localization concept, a view that endured for more than one millennium, the faculties acquired a place in the brain parenchyma.1,2 Further studies revealed new and more precise definitions and locations for these functions, a quest that endured for several centuries.

Here, the period spanning about two centuries between Willis' speculative proposal and Broca's modern scientific reasoning and methods of study, will be analysed.


WILLIS AND BROCA

Willis and Broca are seen by most authors as the first to propose, each in his own way, the localization of a higher function in the brain (Box 1).




First, Thomas Willis localized some functions in the brain parenchyma, such as imagination, memory and appetite,3,4 with the memory in the cerebral cortex, dependent on the flow of the animal spirit, and exemplified by the processes of memory acquisition and remembrance (1664).1,3 He is credited for the primacy to localize a higher function in the brain (cerebral cortex), although presumptively, and without further precision. However, Willis' localization ideas gradually waned.

About two centuries later, Pierre-Paul Broca reported his extraordinary finding, a result of scientific thinking and a stroke of luck. He examined patients with speech loss, some followed by pathological verification, and concluded that the production of articulate language (speech) was related to the posterior part of the 3rd frontal circumvolution of the left hemisphere, where a lesion at this site resulted in 'aphemia' (1861-1865).5-7 Thus, Broca demonstrated, for the first time, a circumscribed specific area related to a higher function, namely, language (speech).

Broca also established that the two hemispheres were different (functional asymmetry, lateralization, specialization) and affirmed the dominance of the left side for speech (1865).7 The primacy of the hemispheric asymmetry proposition constituted a matter of dispute with Gustave Dax, representing his father, the late Marc Dax (see also below).8

Thus, the establishment of a scientifically grounded 'localization of a higher function' and the concept of 'hemispheric specialization' stemmed from the study of a language disorder.


AFTER WILLIS AND BEFORE BROCA

The period between these findings was not a quiescent one, being marked by works of numerous authors. Their studies were based on an almost purely theoretical approach (Swedenborg, Prochaska, Gall) or on clinicopathological analysis of brain lesion cases (Wepfer, Valsalva, Pourfour du Petit, Morgagni, Lallemand, Andral, Rostan, Bouillaud, Dax, among others). Many of these investigations, apparently, were not specifically searching for a location in the brain of higher functions. Nevertheless, numerous reported cases cite speech disorders, but without further comments. Some authors will be highlighted for their special contribution. However, all should be seen as important and certainly helped provide the right environment for such ideas2 (Box 2).




THEORETICAL-BASED VIEW OF LOCALIZATION: SWEDENBORG, PROCHASKA, AND GALL

These authors considered the existence of diverse functions related to distinct cerebral seats where they were supposedly localized, and their theories shared many similarities. However, evidence supporting their presumptive localizations was not robust.

According to Emanuel Swedenborg, different functions must be represented in different anatomical seats at the level of the cerebral cortex. His biological manuscripts (1738-1744) remained unknown for more than one century, and despite finally being published (1882-1887), their impact was delayed.9,10 Jiri (Georg) Prochaska then considered that the various 'cogitating parts' (faculties) required different portions of the cerebrum, but without mentioning a specific localization for them (1779-1784).11,12 Finally, Franz Joseph Gall (with collaboration of Johann Gaspar Spurzheim), recognized distinct functions related to cerebral 'organs', perceived via reliefs of the head (skull), according to his peculiar localization criteria.13,14 He assigned higher (cognitive) functions to the anterior part of the head (frontal 'organs', frontal bone) (1810-1819).14 Gall's (and Spurzheim's) organology, which initially influenced many authors (e.g., Bouillaud, Dax, and others), were discredited relatively quickly. However, his ideas were recognized by many as the main forerunners of the concept of localizationism.2,10


BRAIN LESION-BASED VIEW OF LOCALIZATION: FROM WEPFER TO DAX

These were clinical and clinicopathological studies about brain lesions, represented mainly by cases of apoplexy (hemorrhagic, ischemic), head trauma, and expansive processes. The localization, when mentioned, was only touch on. The higher, better recognized function was related to the language domain15 (Box 3).




Seen as a pioneer of clinicopathological studies,16 Johannes Jakob Wepfer, described numerous cases, most published posthumously (1727).17,18 Vascular apoplexies had presumed brain lesion contralateral to the side of paralysis (as previously proposed by Hippocrates), and the side of a lesion causing a speech disorder could be inferred by the hemiplegia, or by the side of the head injury of traumatic cases.19 However, the lack of pathological verification of these cases precluded any description of the localization of the brain lesion.

Wepfer, seemingly, was not explicitly in search of higher function localization, and apparently, did not understand the relationship between the language impairment and left hemisphere lesion. Indeed, he described, more than once, the presence of 'right hemiplegia with speech loss', without further comments.19 The same can be stated about most subsequent authors who described comparable cases, but without clearly mentioning the value of such findings, until the time of Bouillaud, Dax, and mainly of Broca.

Another outstanding author, Antonio Maria Valsalva, proposed the occurrence of hemiplegia resulting from contralateral brain lesion, affirming that this 'rule' was confirmed by many autopsied cases (1707), which were collected and later published by Morgagni (1761).20-22 Shortly after, Domenico Mistichelli demonstrated anatomically crossing fibers, akin to a woman's tress (treccia di donna), at the level of the medulla oblongata (1709), explaining Valsalva's rule'.23 The disciple and follower of Valsalva, Giovanni Battista Morgagni, presented similar cases and confirmed Valsalva's observation of paralysis contralateral to a brain lesion (1761).22,23

Apparently, Morgagni and Valsalva were not especially interested in disorders of higher functions, making no further comments on the speech problems of their cases, focusing mainly on the hemiplegia opposite to a brain lesion.

An author that also confirmed this finding was François Pourfour du Petit, who examined soldiers with head wounds and opposite side paralysis, eventually followed by pathological examination. He complemented and confirmed his observations experimentally in dogs (1710).24 He also found, on dissection, crossing fibers at the level of the medulla oblongata, mirroring Mistichelli's observation.24 One of his cases, besides right hemiplegia, presented an aphasic manifestation and a left-side cortical-subcortical lesion.24 However, he made no specific comment about this differentiated finding, as his main objective was to explain the contralateral paralysis after head trauma.

Apparently, Pourfour du Petit's case was the first clear description of this clinicopathological picture - right hemiplegia with aphasic symptom and contralateral brain lesion. However, the repercussion of his finding was limited.

An admirer of Gall's work, Jean-Baptiste Bouillaud proposed the existence of a center related to speech functions localized in the frontal lobes (1825).25,26 He failed to mention a possible hemispheric asymmetry, despite reporting cases with predominant left-side lesions (over right) mostly of the frontal lobe, when speech disorders were present.27 Such misinterpretation might be explained by his strict respect for the doctrine of functional symmetry of the hemispheres, a concept dominant at the time, advocated by François-Xavier Bichat.28

Finally, Marc Dax reported three cases that presented a loss of the 'memory for words' (aphasia), with lesion of the left side of the brain. He tentatively identified a pattern that could be a 'general rule'. However, the small number of cases and Bichat's theory of functional symmetry of the hemispheres, limited his hypothesis. Later, a fair number of additional cases, without exception to this 'rule', confirmed his idea. He concluded that the impairment of the 'memory for words' should be attributed to a lesion of the left hemisphere ([1836]1865).29

His conclusion and query about the hemispheric functional difference suggest that he considered the left hemisphere as specific for language disorders, a hemispheric asymmetry.

Thus, the work Marc Dax presented ahead (1836) [allegedly] of Broca, marked the beginning of the awareness of 'functional asymmetry' of the cerebral hemispheres related to a higher function (here, the cognitive domain of language). This view was reinforced by Gustave Dax, who entered a dispute with Broca in defense of his father's priority of this proposition.8,28,29

In conclusion, the period spanning about two centuries between Willis and Broca was marked by numerous authors who published works important for creating an atmosphere that permitted demonstration of the functional asymmetry of the hemispheres (Dax and Broca) and revealed the brain localization of a higher function in the left hemisphere as the language domain (Broca).

In the ensuing few decades, other localizations for further aspects of language were revealed by the likes of Wernicke and Lichtheim. Later, similar findings related to other higher functions (cognitive domains) appeared in publications by Liepmann, Wilbrand, Lissauer, Ribot, Korsakoff, among others.30


REFERENCES

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Cognitive and Behavioral Neurology Unit, INDC - CDA-IPUB - UFRJ Rio de Janeiro-RJ-Brazil

This study was conducted at the Cognitive and Behavioral Neurology Unit, INDC - CDA-IPUB - UFRJ, Rio de Janeiro, RJ, Brazil

Eliasz Engelhardt
Av. N.S. de Copacabana, 749/708
22050-002 Rio de Janeiro RJ - Brazil
eliasz@centroin.net.br

Received February 13, 2018
Accepted after revision March 26, 2019

Disclosure: The authors report no conflicts of interest.

 

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