Journal of Investigative Surgery, 13:297 298, 2000

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Historical Note

A Place in History: Paul Broca

and Cerebral Localization
Scott E. Cowie
3rd Year Medical Student,
University of British Columbia,
Vancouver, BC, Canada

he role of Paul Broca (18241880) in uncovering the cerebral organization of language function is well known. His declaration,
made after considerable clinical study, that we speak with the left
hemisphere has justly resulted in the eponymous naming of the left
inferior frontal lobe [1]. Less well known, however, are the contributions
that Paul Broca made as a surgeon of the brain. These included methods
for the scalp localization of cerebral convolutions, thermoencephalography, and, in 1871, the rst craniotomy made on the basis of a localization
of cerebral function.
Broca was born in a small French town, in the same decade that produced Lord Lister, Louis Pasteur, Herbert Spencer, Charles Baudelaire,
and Johann Strauss. Brocas father was a physician who encouraged his
sons entrance into medical studies at the College Sainte-Barbe in Paris.
Broca, excelling in the competitive Parisian medical system, eventually
became the youngest Aide in anatomy at the age of 22. At 24 Broca found
himself providing surgical care as well as sentry duty at the Hotel-Dieu

during and in the aftermath of the Revolution of 1848 [2]. Following this
was a long career in the various elds of anatomy, ethnology, pathology,
and neurology. However, Broca was rst and foremost a surgeon, and in
1865 was elected president of the Paris Societe de Chirurgie. Like many
surgeons in the nineteenth century, Broca made numerous contributions
to knowledge about the human body. The most important of these was
a diagnostic accomplishment involving a case of an extradural abscess.
In June 1871, a 38-year-old laborer presented himself to Brocas La
Pitie clinic after receiving a kick in the left fronto-parietal region from a
horse. Despite the lack of fracture, 1 month later the patient worsened
and began to show signs of aphasia, responding to all questions only
that It is not going badly. After some time the patient lapsed into full
aphasia and then into coma. Broca began his operation by marking out
a point 5 cm horizontally and 2 cm superiorly from the orbital process.
He then trephined and evacuated the abscess overlying the cerebral
organ of language [3]. Despite the attentions of Broca and the chief
resident, which included further cerebral exploration, the patient became
297

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Historical Note
comatose 11 hours postoperatively, and subsequently died. An autopsy revealed early suppurative involvement of the inferior frontal gyrus.
It is evident from Brocas account of this case that
he was aware of the fundamental neurosurgical principles that the operation established. The reasoning
behind his suspicion of the abscesss location was derived from his earlier investigations of the cerebral
functional areas. These investigations were part of a
broader scienti c and cultural movement that gradually dismantled the concept of a sens orium commune
or common pool of psychic functions in the brain.
Theories formed in the 18th century had postulated
that this seat of the soul lay variously in the ventricles, corpus callosum, or cerebral association tracts
[4]. By 1861, when Broca had submitted his thesis
to the Anthropological Society of Paris concerning
the loss of the speech faculty following a con ned
cerebral lesion, both the scienti c and public imagination had been well prepared by the researches (and
pseudoscience) of Gall and the phrenologists to accept the idea that the brain was a collection of distinct functional regions. Brocas surgery was a logical
application of these principles and observations.
As a professor of surgery, Broca continued to develop other methods to allow accurate localization
of cerebral lesions prior to craniotomy. He invented
some 27 instruments to determine the relationship of
brain and skull. These included the goniometer, craniograph, and other types of stereographic equipment
[5]. Another avenue of research that Broca was able
to apply clinically was that of the recently discovered
signi cance of body temperature in disease, devel-

298

oped primarily through the work of Carl Wunderlich

published in 1868. Brocas own work on the surgical
treatment of aneurysms had shown that there was
a rise in local temperature following an increase in
blood ow [6]. He then developed a thermometric
crown, which used a ring of six insulated mercury
vessels to identify areas of recent infarction and to
guide the decision to operate in cases of fracture.
Broca was a man of many interests and much in uence. He was the rst to assert that trephination
was an ancient therapeutic practice that had allowed
those subjected to it to survive postoperatively, as
evidenced by signs of in ammation on the cranial
wound margins. His contributions to anthropology,
particularly its archaeological and physical branches,
are well known to those in these elds. Broca was an
elected Senator, and a renowned lecturer. It was at
the age of 56 that he died.

REFERENCES
1. Broca P. Sur le siege
`
de la faculte du langage articule.
Bull
Soc Anthropol. 1865;6:377393.
2. Schiller F. Paul Broca, Founder of French Anthropology, Explorer of the Brain. Berkeley: University of California Press;
1979.
3. Broca P. Diagnostic dun abces
` situe au niveau de la region

du langage: Trepanation

de cet abces.
` Rev Anthropol.
1876;5:244248.
4. Walker A. The development of the concept of cerebral localization in the 19th century. Bull Hist Med.
1957;XXXI(2):99119.
5. Garrison F. An Introduction to the History of Medicine,
4th ed. Philadelphia: W. B. Saunders, 19:493.
6. Broca P. Des aneurysmes

et de leur traitement. Paris: Labe

et Asseslin; 1856.

S. E. COWIE