APHASIOLOGY, 2006, 20 (8), 792-810 UBS Psychology Press francs Cte CAC Classics A pre-history of the problem of Broca’s aphasia Hugh Buckingham Louisiana State University, Baton Rouge, LA, USA Twenty-five years ago, 1 wrote this essay for presentation at the May 1981 CAC meeting in Kerrville, TX. There are only a few sections cordoned off by separating lines; most new material with post-1981 citations has been integrated in the text for smoother transitioning. There are small added sections on Descartes, Bouillaud, and on induction in medicine. I have several new “B” headings, which improve the organisation of the essay: The Bell Magendie principle: Muscle sense; Phrenology; The law of symmetry; Memory for language and speech: The French physicians; and The inductive method of clinico-pathological reasoning in medicine and the cerebral localisation of function. The bibliography is accordingly amplified. INTRODUCTION In 1865, Armand Trousseau introduced the term “aphasia” for what Pierre Paul Broca had called “aphemia”’, and several years later, David Ferrier (Critchley, 1964, p. 240) suggested that the inferior third frontal convolution of the left hemisphere be named “Broca’s area”. Since then, investigators have been studying, interpreting and reinterpreting the symptom-complex and the neuroanatomical correlates of that symptomatology, as well as the therapeutic management in patients with the disease (e.g., Kearns, 2005). The purpose of this paper is to present a sketch of what was known about the anatomy and physiology of the human motor system at the time Broca was writing about what he called aphemia. The material will be presented in an historical progression from antiquity to the middle of the 19th century. In addition, I will present some historiographic difficulties in tracing specific continuity of information to Broca. Many questions as to cxactly what Broca knew, or could be reasonably expected to know, have been cleared up by Francis Schiller’s biography ‘Address correspondence to: Hugh W. Buckingham PhD, Deparunent of Communication Seienses & Disorders, Louisiana State University, Baton Rouge, LA 70803, USA. Email: hbuck@Isu.cdu ‘Originally published in: Clinical Aphasiology: Proceedings of the Conference, 1981. Kerrville, TX: BRK. Copyright 1981 by BRK Publishers, © 2006 Prychology Press Lid http://www psypress.com/aphasiology DOI: 10.1080/02687030500334118THE PROBLEM OF BROCA’S APHASIA 793 of Broca (1992). Arthur Benton (1965a), pointed out that many early observations and descriptions of aphasia were indeed not necessarily passed on to each and every future investigator, and as a result quite similar “discoveries” were made centuries later, as if for the first time. ANATOMY AND PHYSIOLOGY OF THE MOTOR SYSTEM TO 1800 Not surprisingly, the distinction between sensation and movement was appreciated in ancient times. Clark and O'Malley (1968) note that Herophilus (c. 300 pc) differentiated motor and sensory nerves in his anatomical studies. Erasistratus (c. 260 Bc), another ancient Greek anatomist, described how both types of the spinal cord originated in the brain. Rufus of Ephesus (fl. AD 98-117), a physician and anatomist, wrote (Clark & O'Malley, 1968, p. 113): “The processes springing from the brain are the sensory and the motor nerves, with the help of which we are able to feel and to move voluntarily and which are responsible for all activities of the body.” Soranus of Ephesus (AD 98-135), whose writings are known through the work of Caelius Aurelianus (fl. AD 450), distinguished between sensory and motor impairments in patients and observed the difference between flaccid and spastic paralysis (Benton & Joynt, 1960, p.207). Then came the Dark Ages, which were “dark” indeed. The Age of Enlightenment brought with it an inerease in scientific inquiry. Mondino De’Luzzi (1270-1326), discovered innovative systematic anatomical patterns from dissections. He studied the structure and role of the cerebellum and felt that it might be the source of the motor nerves. The proximity of the 4th ventricle (the “posterior” ventricle) to the cerebellum suggested to De’Luzzi that memory as well as movement could be a property of cerebellar function. Since the ancient ventricular theories of brain function, memory had been placed in the posterior ventricle. The 17*-century Oxford anatomist, Thomas Willis (Zimmer, 2002), also contributed significantly to our understanding of motor system structures. In his anatomy texts of 1672 and 1681, we find detailed descriptions of the cerebellum as well as of the corpus striatum (the caudate nucleus and the putamen). However, he did not consider the corpus striatum to be motor, but rather to be the area that received all sensations (i.e., the “sensus communis”) Furthermore, the term “striate cortex” or “corpus striatum” subtended many more lower grey matter structures than simply the caudate nucleus and putamen, as we will see later in this paper. In addition, ever since the Hippocratic writers, it has been known that the nervous system is crossed. Numerous early physicians had noted that trauma to one side of the head would cause paralysis on the opposite side of the body. In 1710, Francois Pourfour Du Petit (Clark & O’Malley, 1968) published his anatomical and experimental investigations, where he described the decussation of the pyramids at the medulla. He had observed human cerebral wounds on one side of the bi which caused motor paralysis on the opposite side of the body. He produced similar results with lesion (cortical ablation) experiments on dogs. Therefore, his anatomical findings of the medular crossings provided strong support for the notion of contralateral control (Clarke & O’Malley, 1968). Questions of form ys. function immediately arose with the study of anatomy. Clarke and O'Malley (1968) claim that Galen’s (ap 129-199) most outstanding contributions to medicine were his experimental studies and his insistence upon the794 BUCKINGHAM. necessity of relating form to function. Cartesian doctrine, however, as far as mental function was concerned, held that form and function were separate: one could not be deduced from the other. Psychological phenomena could only be experienced and understood through subjective immediacy (“qualia” in philosophical terms). Anatomists and physiologists could only manipulate and observe the physical realm — not the mental. Finger (1995, 2000) describes some fascinating subtle takes on the pineal gland by Decartes, whereby he considered that the gland was actually movable, and could rock and tilt towards important neuroanatomical structures and locations for mental function. By this mobility, the pineal gland (whose agent was outside the body) could more precisely direct the transmission medium (animal spirits in those days) through the ventricular system or more rapidly into the nerves of the brain. For the most part however, reasoning about mental function (of the “soul” — often used throughout history in our modern sense of the “mind”) from physical structures was felt to be unwarranted. Karl Figlio (1975) pointed out that the French. Academy of Sciences criticised Franz Gall’s work in phrenology, not for his (and Spurtzheim’s) anatomical findings but rather for the functional conclusions he reached based upon anatomical structure. In addition, John and Charles Bell, in the introduction to their popular textbook on anatomy (1804), wrote, “No sensible man will expect, in the most minute and unwearied investigation of the structure of the brain, to find the explanation of its function” (Figlio, 1975, p. 180). The localisation of psychological function up to the beginning of the 19th century was usually speculative and not based upon experimentation or clinicopathological reasoning. By the time Thomas Willis was writing in the 17th century, most all scientists had given up the cardiocentric localisation (of Aristotle) for the cephalocentric localisation (of Plato) of psychological functions (perception! imagination, reasoning, cogitation, judgement, association, and memory) Furthermore, most had shifted their attention from the ventricles of the brain to the solid portions (Clark & Dewhurst, 1972). Willis focused upon the solid portions of the brain, and his functional localisation was not atypical of late 17th and 18th- century anatomists and physiologists. For him, the “corpus striatum” received all sensations. The white matter fibril system was the seat of the imagination, and memories were stored in the cerebral cortex. For Willis, unlike the Greeks, the notion of imagination was more closely aligned with reasoning than with sensory perception. As I will demonstrate, Paul Broca placed heavy importance on the role of the cerebral cortex for memory. From most accounts, Willis seems to include the whole medullary mass when using the term “corpus striatum”, This was not unreasonable in the 17th century since, although the various structures had been differentiated anatomically (medulla oblongada, thalamus. pons. and the striate cortex—putamen and caudate nucleus—and the globus pallidus), they were viewed functionally as a continuum considered to be the “sensorium commune”. Willis’s conception of the sensorium commune was that it served as a “way-station”, so to speak, for sensations coming in and for movements going out (c.g., the basic afferent-efferent system). Involuntary movements were controlled by the cerebellum, while voluntary movements were the domain of the cerebrum. It is from the work ofTHE PROBLEM OF BROCA’S APHASIA 795, Willis, then, that we are provided several crucial components, later observed in Broca’s thinking: (1) the “corpus striatum” as a lower centre involved in direct motor stimulations for movement; (2) memory mediated in the cortex; (3) volitional! wilful movements directed by the cortex in some unspecified and otherwise unexplained communication with the corpus striatum The notions of voluntary vs. involuntary (reflex-like) movements and the relationship between the “will” and volitional movement had been discussed long before Willis. Futhermore. the conceptualisations of “intellect” had always been linked to wilful/volitional acts. All of these functions were understood to be products of the “soul”, again, most often stripped of any necessary theology. For instance, Rufus of Ephesus (fl. aD 98-117) was aware that the motor nerves from the brain were involved with voluntary movement. Even before Rufus, Plato and Hippocrates claimed that wilful movements stemmed from the brain. In addition, Galen (av 129- 199) wrote, “*... therefore, we shall agree with Plato and Hippocrates ... that the brain is the source of voluntary motion” (Clark & O'Malley, 1968, p. 15). Since the “soul” was the realm of wilful phenomena as well as the mechanism of the intellect, it was natural to consider language to be expressed through willed movements of the imtellect and as a direct product of the soul. As Aristotle put it, “... the mind is the source of speech” (Critchley, 1964, p.231) EARLY OBSERVATIONS OF MOTOR APHASIA ‘The descriptions of what were likely to have been motor aphasias before 1800 most often lacked any indication of the site of lesion in the brain. Up to the turn of the 19th century, clinicopathological studies of adult aphasic syndromes were rare. Moreover, two accepted premises militated against neuroanatomical localisation of language function from aphasia investigation. First, much before the middle of the 19th century, the cerebral cortex was considered equipotential and functionally indivisible. Only a few dared cross the cortical “soul” with specific locations for functions—except for intellect, volition, and memory. One sees in these descriptions of aphasias primarily observational reports of patient behaviour with little if any concomitant neuropathological correlation. In Benton and Joynt (1960), Critchley (1964) and Benton (1965a, 2000) we find reports of early descriptions of several types of aphasias—most of which were motor in nature. The significant work of Johann Gesner (Benton, 1965b) in 1770 and of Alexander Crichton (Finger & Buckingham, 1994) in 1798 were notable exceptions, in that they provided detailed sketches of fluent aphasias with associationistic accounts of paraphasias and naming disruptions. For the purposes of this paper, the focus will concentrate on the non-fluent syndromes, for they relate more directly to Broca’s contributions. If historians go back thirty centuries before Christ to the famous Edwin Smith papyrus, they will find a case of a speechless patient with a traumatic lesion described briefly (Critchley, 1964). Later on, the Hippocratic writers (c. 400 Bc) described subjects who were “anaudos” (speechless) and those who were “aphonos” (voiceless) (Benton & Joynt,796 BUCKINGHAM 1960). However, from most of the observations and translations, one cannot always be sure of when the writers were describing aphasia, apraxia, dysarthria or loss of voice—such as occurs often with hysteria. In addition, the Hippocratic writers noted that patients with transient “anaudos” also presented with, “... paralysis of the tongue, or of the arm and right side of the body” (Benton & Joynt, 1960, p.206). Consequently, the Hippocratic writers should be credited with first observing that speech disorders could be accompanied by a right-sided paralysis. Johann Schmidt in 1673, Peter Rommel in 1683, Olof Dalin in 1745, and G. B. Morgagni in 1762, each described motor aphasia with right-sided paralysis (Benton & Joynt, 1960, 1963). The descriptions of Rommel and Schmidt are considered to be the most outstanding early studies of motor aphasia. Rommel referred to the syndrome as a “rare aphonia”; the patient could not speak fluently, nor repeat. However, Rommel noted that the patient could comprehend written and spoken language and had retained the capacity for serial speech (Lord’s Prayer, Apostles’ Creed, some biblical verses, and other prayers) (Benton & Joynt, 1960). Dalin wrote that his patient, despite his complete loss of speech, could still sing certain hymns that he knew before the illness (Benton & Joynt, 1960). Aside from noting that patients such as these could not speak, but could comprehend, Morgagni stressed that there was most often a right-sided paralysis and that subsequent autopsy when available frequently revealed disease or injury of the le/t cerebral hemisphere. However, he never correlated any of this unequivocally with the aphasia (Benton & Joynt, 1960). The writings of Willis also contain a few descriptions of motor aphasia where the patient had “... a palsie ... of the whole right side’’, or where the patient was concurrently “... paralytick in all his right side” (Critchley, 1964, p. 234) Still another significant aspect of motor aphasia had been appreciated well before the turn of the 19th century. This was the observation that faulty articulation of speech did not necessarily imply lingual paralysis. Soranus of Ephesus in the 2nd century distinguished speech output problems due to paralysis of the tongue from cases of loss of speech resulting from some other disease, where “... the tongue does not change color or the condition of its surface, or lose sensation or mobility, or change position” (Benton & Joynt, 1960, p. 207). The famous Renaissance physician Paracelsus also observed that defects of speech could occur in the absence of paralysis (Benton & Joynt, 1960). The 16th-century medical scholar Johann Schenck von Grafenberg wrote that “I have observed in many cases of apoplexy, lethargy and similar major diseases of the brain that, although the tongue was not paralyzed, the patient could not speak because, the faculty of memory being abolished, the words were not produced” (Benton, 1965a, p. 317). In 1770 Johan Gesner described, aside from his fluent cases, a case where the “... expressive aphasia could not be interpreted as merely a paralysis of the tongue or any other organ” (Benton & Joynt, 1960, p. 214). In sum, a good deal concerning motor speech disorders had been described before 1800: (1) speech output difficulty with and without lingual paralysis; (2) concomitant right-sided paralysis; (3) relatively intact comprehension; (4) left hemisphere lesions; and (5) speech disruption despite retention of automatic speech, serial speech and singing. These observations aside, Benton (1965a, p. 321) claimed that prior to the turn of the 19th century, “Beyond the recognition that aphasia was a manifestation of disease of the brain, there was little interest or knowledge in the neuropathological basis of the disorder.”THE PROBLEM OF BROCA’S APHASIA 797 IMMEDIATE PRECURSORS OF BROCA In reality, it was not the prior descriptions of motor aphasia that provided the impetus for Broca’s efforts, but rather the new round of arguments concerning the localisation of function in the human cerebral cortex, or certain regions subjacent to the cortex. To localise or not to localise mental function in physical brain regions had been one of the principal, if not the principal, argument points in mind—brain logjams literally for centuries. At the turn of the 19th century, alchemy had its counterpart in neuropsychology—phrenology. Like alchemy, phrenology had formed many of the foundational tenets of the neuropsychological study of brain structure and behaviour. Gall and Spurzheim argued that numerous sorts of mental, psychological, and personality traits were indeed the product of cerebral function and that the higher nervous system was a modular array of regional centres that mediated the traits and capacities of Man and animal. In addition to the phrenological influence, the late 18th and early 19th centuries saw the rise of experimental physiology as well as the development of a clinico-pathological methodology largely due to the increased influence and interaction of physicians and anatomists, focusing upon the cpiphenomena of brain damage in discased populations and attempting to correlate those phenomena with neuroanatomical function. The Bel! To begin with, Broca’s contributions must be understood within the context of the so-called “Bell-Magendic” motor-sensory dichotomy (on “so-called”, see Jorgensen, 2003; see also Young, 1990). In order to understand fully how the Bell-Magendie principle progressed, one must be aware of how the “sensorium commune” came to be physically explorable and knowable. Figlio’s (1975) thesis is that the 18th century bore witness to the emergence of the hitherto purely phenomenological ““sensorium commune”, as a natural object, a somewhat quixotic move by the then growing number of “natural” philosophers to scientifically objectify mentality. Both Albrecht von Haller and Samuel Thomas Sommering experimented on the lower nervous structures in the latter half of the 18th century, searching for areas whose stimulation provoked convulsions. Even by the late 18th century, the “medullary mass” (medulla, corpus striatum, thalamus, and pons) was considered to be a functional continuum, although the anatomical forms were being distinguished with increasing clarity. Sommering (publishing his ideas in the period 1791-1796) conceived of the medullary mass as interacting in some fashion with Sommering’s notion of the “sensorium”, which he felt was located in the ventricular fluid. Importantly, he could find no effect from cortical stimulation. Ancient Greek ventricular theories of mental function died an extremely slow death in the history of tracing those functions. Although as pointed out earlier in this paper, Willis had stressed the importance of the solid portions of the higher nervous system, but that observation did not immediately catch on. Up to the turn of the 19th century approximately, the so- called “‘sensorium” was a useful guiding concept in that it referred to that point at which all sensory nerves converged. It was the seat of the “unity of consciousness”, and it was there where the “will” was located, where the intellect (judgement, reason, association) was located. and, for many, where memory was located. Nevertheless, movement was not emphasised to the extent that sensation was until the dawn of the Magendie principle798 BUCKINGHAM 10th century. Consequently, most descriptions of the sensorium considered it to be a nervous endstage for all perceptual modalities. Sensation had been highlighted over movement, because epistemological theories tended to focus upon how we learn and attain knowledge through perceiving the world and then how we interrelate the various perceptions by association. Early associationists stressed sensations almost to the exclusion of movement, the major exception being David Hartley (Buckingham & Finger, 1997). They invoked the concept of the sensorium as the seat of all Sensation. Riese and Hoff (1950) point to the various localisations given for the sensorium: cerebral ventricles, corpus callosum, corpus striatum, pons, corpora quadrigemina, thalamus, and other lower structures. As mentioned above, many took the sensorium to be the whole of the “medullary mass”. By the last quarter or so of the 18th century, the stage was set for the experiments of the Scotsman Sir Charles Bell, of the Frenchman Francois Magendie, and from the “motor-sensory”” principle, which took root from their work, although as mentioned earlier, the ancient Greeks had distinguished motor and sensory nerves at the level of the cord. Sir Charles Bell (1774-1842) is usually credited with the first modern proposal of the motor-sensory division at the level of the spinal cord in 1807 (Carmichael, 1926) Bell was actually an outspoken critic of animal physiological experimentation; he drew his conclusions largely from the study of anatomy and natural motions (Young, 1990). Magendie was considered the father of experimental physiology in France. Schiller (1968) has written that all the history of scientific physiology in the first of the 19th century revolves around Magendie. It has been said (Young, 1990) that what Bell described in 1807 anatomically, Magendie verified physiologically 14 years later in 1821. Going beyond Bell and Magendie, Young (1990) claims that their hypothesis was not truly vindicated until the experimental studies of Johannes Muller in 1831. Two immediate consequences of the Bell-Magendie “law” were forthcoming. First, there was now clear experimental evidence that the medullary mass was not simply a holistic functional continuum, but rather had discrete motor sensory characteristies—discoverable through experimentation. The second result was that it became metaphysically necessary to remove any remnants of the will, the intellect, and memory from the medullary mass and to place them unambiguously up one notch to the grey matter of the cerebral convolutions, under the agreed-upon assumption that regions of raw motor/sensory function could not possibly be commensurate with the organs of volition, intellect, or memory. At this point in history. therefore, the cortical “will” assumed the role of directing the medullary motor centres for volitional movement. Magendie, in a later publication of 1843, wrote that “... the will and the action of the brain, which produces directly the contraction of the muscles, are two distinct phenomena” (Young, 1990, p.87). He placed the “will” in the cerebral hemispheres, and the “direct” motor centre in the “medulla spinalis”. We can appreciate which functions were actually ascribed to the volitional system by Magendie, when he described motions from the lower centres after those centres had been separated from the cortex. He wrote that “When we prevent the will from determining and directing these motions, they are nevertheless executed; however, they become irregular in extent, rapidity, duration, and direction” (Young, 1990, p.87). Thus, for Magendie, the will was a type of “action” which caused, but did not directly execute, volitional movements. The rhetorical ploy, of course, was the establishment of more than one level of causation—a move often made in different guises. The actual production (e.g.. the “immediate” cause) of the muscular contraction was associated with the spinal nerve roots, spinal cord,‘THE PROBLEM OF BROCA’S APHASIA 799 corpora quadrigemina, cerebral peduncles, thalamus, corpora striata, and cerebel- lum. Once the posterior spinal roots were shown to be sensory and the anterior roots to be motor, the remainder of experimental sensory-motor physiolology was “ primarily concerned with tracing the progressive application of this functional division to successively higher parts of the central nervous system ... ” (Young. 1990. p.79). We can now pinpoint the decade (1860-1870) of Broca’s principal contributions to the study of aphasia within this progressive movement up the neuraxis at a point just short of the cerebral cortex. As we will see presently, Broca (1861) stated flatly that all knew the cerebral hemispheres not to house motor functions. At the time Broca was writing and presenting material to the Anthropological Society of Paris, the highest direct motor centre was thought to be the corpus striatum, while the highest discretely localisable sensory centre was felt to be the thalamus. Young (1990) gives credit to Robert Todd and William Bowman for ultimately boosting the Bell-Magendie principle to these structures. Young (1990) quotes from their text on anatomy and physiology: “The corpora Striata and optic thalamus bear to each other a relation analogous to that of the anterior to the posterior horn of the spinal gray matter. The corpora striata and the anterior horns are centers of motion; the optic thalami and posterior horns are centers of sensation” (p. 112). Before 1845, Flourens and Mueller had moved the dichotomy up to the medulla oblongata. Interestingly enough, as early as 1809, Luigi Rolando had evoked contractions from electrically stimulating the cerebral hemispheres of a pig. Although Rolando concluded from this that the cortex contained actual fibers for volitional movement. his observations fell on deaf ears because the scientific paradigm of the time accepted the view of a non-motoric cortex. This was coupled with the criticism that in electrical excitation studies, the movements produced were actually due to the direct spread of an intense current through the unstimulable cortex to the lower structures—an argument used, interestingly enough, at the outset of the electro- cortical stimulation studies of Penfield and Roberts (1959). Muscle sense Before turning to the influence of the phrenologists, some discussion of the development of theories of movement and of the concept of “muscle sense” is in order. This essentially dichotomous concept of muscle sense combined motor and sensory (movement and sensation) phenomena. Through the work of David Hartley (1746, 1749; Buckingham & Finger, 1997) and subsequently of Johannes Mueller and Alexander Bain, association psychology developed into a general psychological theory, which increasingly included motion—both voluntary and involuntary. The basic idea was that moving a limb. for instance, would give rise to a sensational impression of that movement recorded within the nervous system. Repeated instances of the movement would further entrench the sensory impression: an association was accordingly forged between the two. Subsequently, the sensory impression would acquire the power of “calling up” the movement. By 1842, Mueller had developed this “motor theory”, which Young (1990) judged as a synthesis of the Bell-Magendie sensory-motor physiology and association psychology. Its influence was soon evident in Bastian’s (1869) insistence upon a kinaesthetic component in motor aphasia. Nevertheless, in the early 19th century there remained a distinction between sensory-motor function (thalamus-corpora striata) on the one hand and800 BUCKINGHAM “intellect” and “will” on the other. In addition, Pierre Flourens’s influence was extensive, and most researchers believed the cortex to be unresponsive to irritation and hence better conceived of as the seat of the will and intellect—not of raw sensory-motor function. The phrenologists, on the other hand, were not at all hesitant in assigning discrete functional and personality roles to cerebral zones. Phrenology Without a doubt, no discussion of direct precursors of Broca would be complete without consideration of the contributions of Franz Gall (1758-1825). Benton (1965a), Critchley (1964), Joynt (1964), Schiller (1992), Young (1990), Riese (1977) and Riese and Hoff (1950) have all alluded to the continuity from Gall to Broca. Haymaker and Schiller (1970) reflected the opinion of most historians of neuropsychology when they wrote that “Franz Joseph Gall, the scholar and anatomist, is buried under Gall, the showman and phrenologist ..." (p. 31). Hacaen and Albert (1978) claimed that “Gall, by introducing the concept of phrenology, was the first to propose a systematic relationship between specific psychological components of human behavior and specific cerebral regions’ (p. 13). Temkin (1953), Ackernknecht (1958), Young (1990), Bynum (1975), and others have lauded the high quality of Gall’s anatomical contributions. Through his anatomical studies he clearly established the basic division between white and grey matter. He recognised the grey matter as “the matrix of the nerves” and noted the “conductor” function of the white matter, which he observed to be fibrous in nature (see Wallace, 2003). He is usually credited with contributing to our modern understanding of the CNS pathways: U-shape fibres, association fibres, projection fibres and commissural fibres. He provided further description of the pyramidal decussation and added evidence that many cranial nerves originate in the medulla as well as in the pons. Although considered by most to be a materialist, Gall always argued that function was primary—and anatomical localisation secondary. He repeatedly claimed that direct study of the brain could never be a substitute for psychology (Young, 1990). Gall’s reasoning with respect to the nervous system and its relationships to behaviour are of considerable importance in the history of neuropsychology. In establishing ‘clear guidelines for isolating and discovering behavioural faculty categories, Gall arrived at the concept of separate disruptability of function, which, as a way of arguing or reasoning about functional anatomy, is still used today. In point of history, Galen, in the 2nd century. reasoned that each mental faculty could be separated from the others on the basis of their dissociation in pathology (Clark & Malley, 1968). Gall went even further in functional isolation when he reasoned that if two functions have different development patterns and timetables, they are separable. Gall then reasoned that functional separability implied distinct mechan- isms, which in turn logically called for different anatomical locations. The law of symmetry Gall, as well as Spurzheim, made substantial contributions regarding different aspects of language and its disturbances. To begin with (1835, Vol 2) they completely bought into the “law of symmetry” (Bichat, 1805). That “law” stipulated that mental faculties were doubly represented in both hemispheres and consequently that a-faculty might not be destroyed if only one hemisphere were damaged.THE PROBLEM OF BROCA’S APHASIA 801 Symmetry was almost taken for granted by practically every investigator of nervous system function: it was a scientific assumption that had strong theological backing, indeed. The deep-seated reasoning was that God had created Man in his own image and that was certainly not to be an asymmetrical image. Furthermore, the animal kingdom as a whole had clear symmetrical structures, and most neuroanatomists had claimed that the nervous system appeared symmetrical as well. The cortical hemispheres were considered symmetric on the whole, although Gall introduced the possibility of regional size asymmetries. No one in the first quarter of the 19th century was aware of anything as bizarre as lateralised hemispheric function. Evidently only a very selected few (history has come up with no more) were aware of Mare Day’s alleged pronouncements on unilateral left hemisphere function for articulate speech and its correlation with right- handedness in 1836 (Cubelli & Montagna, 1994; Finger & Roe, 1996, 1999; Roe & Finger, 1996). Furthermore, clinico-pathological evidence for exact localisation of the faculty of speech within the anterior lobes of either hemisphere was so imprecise that even by 4 April 1861, Ernest Auburtin had to admit that, “... the anterior lobes are of considerable size and the precise point where the faculty of speech resides has not yet been determined” (Clarke & O'Malley. 1968. p.493). A memory for language and for speech In addition to articulate language, it is important to realise that Gall believed there to be a general faculty of language as well, which for him was the ability to attend to and distinguish words. Of utmost importance for this faculty was the recollection of words, or “verbal memory”. This was faculty #33, located at the orbits. In Gall’s words (Clark & O’Malley, 1968, p.479), “I regard as the organ of memory of words that part of the brain which rests on the posterior half of the orbital roof ...”” When this cortical area was large, the result was that,“‘... the eyeball must be pushed forward” (Clark & O"Malley, 1968, p.479). This general language faculty was primarily for comprehension and verbal memory. By memory in his sense, Gall did not have in mind articulation, but rather a capacity for the memory of verbal material, such as poems, lines in plays, soliloquies, and other stretches of verbal material. For Gall, this verbal memory for the general faculty of language involved word sense, not the articulation of those words. Admittedly, there is some ambiguity in Gall’s use of the term “memory” when characterising his conception of the general faculty of language, since at times he talks about the ability to simply memorise and recall verbal material and at other times he seems to be describing what we now understand as long-term lexical memory. Nonetheless, Gall conceived of separate faculties for verbal memory and for verbal articulation. His reasoning was that one could be damaged, while the other remained intact—another instance of arguing for separate mechanisms from differential disruption in pathology. In Gall and Spurzheim (1835, Vol. 5) we find a description of a patient who, although suffering a right-sided paralysis, appeared to have word and proper name finding difficulties with well-articulated indefinite pro-forms as “Mr. such-a-one” (p. 17). In addition, there were cases described by Gall and Spurzheim (1835, Vol.5) where the patient was “... unable to express his802 BUCKINGHAM sentiments and ideas by spoken language” (p.23). They noted that the patient had not lost his intellectual powers, could comprehend and could demonstrate that he had not lost his verbal memory in terms of the sense of words, since, although incapable of articulating “arm chair” when asked about it, the patient “*... answered me by sitting down in the chair” (p. 23). In reading Gall and Spurzheim it is clear that they divided language into distinct domains (modular?) of memory—memory for the sense of words, memory for the articulation of words, and even, according to Henry Head (1926) a memory for grammatical patterns. A significant bi-partite view of speech was slowly emerging and it played a crucial role in understanding what Broca was grappling with later. One level for understanding speech articulation was at the raw motor movement system, always located one level below the higher “intellectual” levels where memory was located. The faculties of language that Gall spoke of were all considered to be intellectual, since they were memorial systems and memory belonged to the intellect. Of course, the point was that patients could lose one type of memory and not another: memory was looking more like a set of modules. In general, then, for Gall and Spurzheim (1835) as well as for other phrenologists, the cerebral organs mediating these “intellectual faculties” of language and speech were located in those anterior frontal convolutions which border the orbits. In reality, however, apparently all one had to do in the first half of the 19th century was to demonstrate some language deficit secondary to frontal lobe damage—a roughly anterior localisation. Moreover, in strict accordance with the law of symmetry, the phrenologists’ model was supported with damage to cither the left, the right or both hemispheres. Again, few if any investigators at this time in history even considered the possibility of Man’s language as lopsided, i.e. asymmetrical—not even the phrenologists. ‘The bi-partite nature of speech is the crucial notion to focus upon with respect to the continuity from Gall to Broca, since “aphemia” was essentially understood to be an articulatory disorder. According to Head (1926), Gall felt that “The human nervous system does not differ fundamentally in structure from that of the beasts; its functions are identical in quality but more highly developed” (p. 7). Thus, for Gall, animals have a faculty of language as well, but theirs is primarily communicated and received via gestural systems. Gall and Spurzheim (1835, Vol. 5) wrote that “... all possible signs, the language of gesture as well as verbal language, are the product of the activity of the faculties, inclinations, affections and passions of men and animals” (p.34). Gall and Spurzheim are clearly claiming that language is not necessarily species-specific—but again, the whole question revolves around just how one defines “language”. Dingwall (1975, 1979) and Lieberman (1975) have provided much discussion of the neurobiological evolution of communication output systems in animals. Their takes are essentially that articulatory exteriorisation of human language is in some ways obviously superior in complexity, agility, and speed to hand/arm limb gestures The issue is one of whether the systems are qualitatively different or quantitatively different. Gall and Spurzheim most certainly claimed that articulatory gesturing is far superior to hand/arm gesturing as an output modality—and quite advantageous evolutionarily. The memory of articulate speech in Man is then quite important, and the faculty for that memory accordingly takes on a special role for human language. ‘There is a very significant passage from Gall and Spurzheim (1835, Vol. 5, p.36) concerning the efficiency of verbal articulatory communication of language in Man:THE PROBLEM OF BROCA’S APHASIA — 803 Verbal language, it is true, is of all languages convenient to employ; it needs neither i figures; it requires neither space nor freedom of limbs as for gestures; in whatever position one is, maimed, sick, acting, he can produce this language. It is heard as well By hight as by day, at a distance as well as near, without being earnestly attentive, without tren wishing it. These properties, which sounds possess. of being the most natural and the most convenient of signs, cause them to become by custom the most habitual of all, find within us they are the most intimately connected with the ideas which they represent Unfortunately, as we mentioned above, the phrenological contributions concerning the faculty of articulate speech did not include any unequivocally clear-cut region within the anterior lobe. This, of course, was left to Broca. The French Physicians In addition to Jean Baptiste Bouillaud and Ernest Auburtin, there are several other intermediaries connecting phrenological theory with Broca. For instance, Jules Soury, a neurologist and well-known historian of the nervous system, was. a student of Gall, and at several places Broca expressed his admiration for Soury (Ackerknecht, 1958; Schiller, 1992). Achille-Louis-Francois Foville, a famed Trench anatomist in the early 19th century, had read Gall in depth and was highly influenced by his work. Foville had been one of Broca’s professors in medical school (Ackerknecht, 1958; Schiller, 1992). It appears, however, that Foville was much nore impressed with the anatomical work of Gall than with many of the tenets of phrenology, since Schiller (1992) writes that Foville envisaged the cerebral cortex a being in its entirety an organ of the intellect. This was Pierre Flourens’s view as well, end Flourens was an ardent anti-phrenologist. It must be mentioned, however, that Gall considered all the faculties of the anterior lobes to be intellectual-—language being the primary example, Even the phrenologisis were convinced that no direct moter or sensory function existed at such a high level in the nervous system as the cerebrum. It is well known that in his August 1861 paper (von Bonin, 1960), Broca accepted that it was an open question (Young, 1990) whether aphemia and speech in general involved intellectual or motor functions. It is also well known that Broca opted ultimately for the intellect—referring to it as the intellectual faculty for the taemory of articulated sounds. He was thus in agreement with all three: Gall, Elourens, and Foville. The major disagreement between Flourens and the phrenologists was not over whether or not the cortex was the mediator of Patelligence, but rather it involved the discrete parcelling out and localisation by the phrenologists of such an array of distinct (and in a sense, modular) intellectual functions, faculties, or memories in different cerebral regions. This move was anathema to those who, like Flourens, believed that the cortex was an unanalysable functional whole, which served the intellect and the will equipotentially. This, of course, was the widely accepted conception of the “sensorium”, as pointed out carlier, First, it was the medullary mass, but as experimental physiology progressed in that region, its earthly motor-sensory character was increasingly revealed, slowly pushing the ‘“sensorium” up another level to the cerebral cortex, which then took: on the nature of a “sensorium”. It has often been said that as the Bell-Magendic sensory-motor dichotomy moved up the neuraxis, the will and the intellect were804 BUCKINGHAM being chased up the system and accordingly were being “crowded out”. The phrenologists were convinced that the intellectual functions of the cortex could be modularised, and again Broca was reading their texts and being trained by followers of Gall. Schiller (1992) further documents that Broca’s early medical school curriculum included a course in “Therapeutics” with Gabriel Andral, who, according to Ackerknecht (1958), was once president of the Société de Phrenologie and was indebted to Gall for many of his ideas. In addition to these French physicians (Soury, Foville, Andral) as presumed sources for phrenologi influence upon Broca, the most well-known connections come from Jean-Baptiste Bouillaud and Ernest Auburtin (Head, 1926, Vol.1; Clarke & O’Malley, 1968; Stookey, 1963; Young, 1990), especially in cases that concerned language and speech localisation in the cortex. In a series of publications roughly from 1825 until 1848, Bouillaud presented -o-pathological data purporting to support and confirm Gall’s location of the intellectual organ of language, which included the intellectual function of memory (which, itself, always required a wilful jumpstart) for articulate speech (caveat lector Luzzatti & Whitaker, 2001, where we are told that Bouillaud often argued fallaciously, fudged data, and slanted case studies in the literature to fit his phrenology). The reader must keep in mind, however, that Gall was not always precise in distinguishing the organ for language (localised as faculty #33 at the orbits, bilaterally) from the organ for speech. Furthermore it is patently unclear where Gall placed articulate speech in the scheme of things; it did not appear to be over the orbits of the frontal lobe. As it turned out, all one had to do, or so it seemed, was to produce a patient with some form of “pert de la parole” (speech loss), who subsequently died, and where there was autopsy evidence of frontal lobe involvement (region not specified) in either hemisphere, in order to “confirm” (**confirmer” in Bouillaud’s 1825 title) Gall’s theory. Again, recall that even Auburtin in 1861 wrote that there was little if any real specificity within the frontal regions for speech. Bouillaud’s publications (e.g., 1825) were of historical importance, and at many points antedate Broca. For one thing, Bouillaud distinguished between: (1) the lower (subcortical) nerves and peripheral vocal wact musculature for speech; (2) an intellectual faculty comprising a memory for articulatory movement procedures; (3) another faculty for memory of the “senses” of words. Quite obviously, he was drawing from Gall. Like Johannes Mueller and Alexander Bain (Young. 1990), Bouillaud hypothesised that most all complex movement patterns—especially those of articulate speech in Man—were directed by intelligence and volition. By this time in 19th-century neuro-scientific history, intelligence, and will were considered to be cortical phenomena and they “played upon” the lower motor centres, which gave rise to the “raw” and “direct” nervous innervation. Aristotle would refer to the lower structure causes as the “efficient cause”, related to the actual physical force involved in the production of a movement, distinguishing as well the pyramidal tract, the cranial nerves, and the various synaptic structures that in turn cause the muscles to contract, forcing bony structures to move. The cerebral centre for speech was in the anterior lobes—region unspecified. Of the speech region, Bouillaud in 1825 could only go as far as to claim that “... this cerebral center occupies the anterior lobes” (Clark & O'Malley, 1968, p.491). Moreover, there is some revealing evidence that Bouillaud was at least somewhat ambivalent on the exact nature of the contribution of the cortex for speech innervation. From the Clarke and O'Malley (1968) translation of major portions ofTHE PROBLEM OF BROCA’S APHASIA = 805 Bouillaud’s 1825 article, we sce the quandary: “... the nerves which animate the muscles which cooperate in the production of speech, for example, have their origin in the anterior lobes, or at least have essential communications with them” (p. 491). Obviously Bouillaud, as well as Broca 36 years later, was forced into this vacillation due to the paradigm constraints set forth by the limited progress upwards of the Bell- Magendie principle. Broca provided succinct commentary in his August, 1861, major paper (translated by G. von Bonin, 1960): “Everyone knows that the cerebral convolutions are not motor organs” (p.70). Not until science was ready (pace Luigi Rolando) did the demonstrations of cortical excitability by Fritsch and Hitzig (1870/ 1960) finally convince the scientific community that a neuroanatomical level higher than the corpus striatum could be considered motoric in the sense of “raw” innervation. Therefore, Bouillaud’s caveat was well motivated at the time. Nerves which innervate muscles for voluntary movement might not have their origins in the anterior lobes, but they must at least “‘communicate” somehow with the anterior lobes. Unfortunately, Bouillaud did not enter into a discussion as to just what kind of “communication” he conceived of. As the “sensorium” was pushed to ever higher levels, the “communication” between it and the next lower centre constantly adumbrated the “mind-brain” barrier, or the “‘soul-brain” barrier, whereby anything. but metaphor to map the mental and the physical remained bewilderingly recondite. Bouillaud’s notion of the special “memory” for articulation was practically borrowed in toto by Broca. The nature of the faculty of articulate speech involved a particular kind of memory for the procedures one has to follow in order to articulate words. As pointed out above, this type of memory could be functionally dissociated from other kinds language memories—especially lexical memory and background memory so important for comprehension. The loss of memory for speech, although an intellectual faculty, did not imply loss of the whole of intelligence. As Bouillaud was fully aware, the patients with “pert de la parole” demonstrated the maintenance of other intellectual capacities, since they could often understand spoken and written language. In a published communication in 1839, Bouillaud made special note of the fact that some of the cases of speech loss were not accompanied by writing problems. These observations were most often used to modularise memory, and in this case to isolate an autonomous faculty for speech output alone. The inductive method of clinico-pathological reasoning in medicine To a large extent, the doctrine of cerebral localisation of function from the turn of the 19th century onwards was promulgated by the clinico-pathological method, and forms of reasoning and argumentation took shape accordingly. The whole enterprise assumed a largely inductive view of science; it essentially reflected the clinical modus operandi of physicians. Stephen Jacyna (2000, p.84f1) discusses induction and the reasoning of physicians in 19'"-century neuroscience. He quotes the remarks of the early ‘American neurologist, Moses Allen Starr (see Buckingham, 1999, for Starr’s influence on Freud's theories of paraphasia). In 1889, Starr delivered a lecture to the Congress of American Physicians and surgeons, where he claimed that “There is no subject in the domain of medical science which enforces more806 BUCKINGHAM strongly the necessity of following closely the inductive method of reasoning than this one of cerebral localization” (cited in Jacyna, 2000, p. $4). Based upon prior correlated observations of some localised lesion X and some resulting (disrupted) set of behaviours Y, then in some future case, if Y is observed, then X is predicted. To the extent that the observations of Y correlate with successful predictions of X, the statistical likelihood of the prediction increases; otherwise, it decreases. Byron Stookey (1963) documents two famous inductive wagers—one by Bouillaud and the other by Auburtin. Both presumably laid their localisation theories on the line. Bouillaud, in January of 1848, offered S00 francs to anyone who could produce a patient with a profound deep lesion of the anterior lobes but with no speech problem. Bouillaud was predicting the syndrome (speech problem) from the lesion. Later, on 4 April 1861, Auburtin did not offer 500 francs, but did claim at a meeting that he would renounce his localisationist position were someone to present to him a patient with a speech loss who subsequently died and came to autopsy, and if at autopsy the anterior lobes were found to be normal. As it turned out, Bouillaud eventually lost his wager to Alfred Velpeau in 1865 (Schiller, 1992) who indeed observed and documented a patient with destroyed frontal lobes, but with no pre- morbid speech problems. Schiller (1992) writes, “After a long and heated discussion, Bouillaud had to pay” (p. 199). But did this negative case disprove anything? The answer is no. What it did do, and in fact what all ensuing negative cases did, was to force further examination and theory revision in order to maintain the overall localisationist paradigm, while simultaneously coming to grips with the non-confirmatory findings, which in any case cannot disprove an inductive theory. Bertrand Russell (1912) observes that things which in the past have been observed to occur together (syndrome and lesion in certain cerebral zones, in our case) may not be found together in some future case, but to the extent that they indeed have been found together in a great many cases, the probabilistic statement that they will co-occur in some future instance is quite valid. An occasional negative case certainly did not appear to worry Broca. For instance, regarding an earlier negative case of Charcot a patient with aphemia from a supramarginal gyrus lesion—Broca wrote, “One negative fact does not destroy this series of positive ones; in pathology and especially in cerebral pathology, there is no rule without some exception” (Schiller, 1992, p.190). A great deal of scientific knowledge actually accrues through investigative attempts to account for negative cases, but valid inductive inference is never “disproved”. In any event, the localisation position still holds today, and even more legitimately in its weaker form, which simply claims that there are certain types of functions which are predictably vulnerable to disruption secondary to damage of specific cortical regions. One can hold to this view, while simultaneously appreciating the caveat stated by Hughlings-Jackson that localising the zones whose damage gives rise to the disruption of language components X and Y does not necessarily imply that components X and Y are located in those precise zones. A form of the weak version of localisation is still in vogue today, although mosaics and distributed neural networks are replacing the localistic zeal of classical aphasiology. Christman and Boutsen (2006), discussing recent work by Marcel Mesulam (1990) on the nature of nodal” zones within distributed systems, write, “Distributed neural networks areTHE PROBLEM OF BROCA’S APHASIA 807 comprised of interconnected neurosynaptic circuits, some elements of which may be distant, but all of which converge on local nodal processing zones that are crucial for network operations” (p. 1). These nodal areas are Brodmann areas 22 (Wernicke’s area) and 44 and 45 (Broca’s area). The initial overly strong claims for localisation resulted from phrenological vigour and dogma, and no little salesmanship not only by Gall and Spurzheim, but also by Bouillaud, Auburtin, and Broca himself. Those claims were that the seat (siége) of the faculty of articulate speech was located in the anterior lobes. Broca’s principal contribution was to more precisely sharpen that localisation upon the inferior foot of the third frontal convolution within the anterior zone, and several years later, despite the protestations of Gustave Dax, the son of Mare Dax, to single out the left hemisphere as the dominant one. CONCLUDING REMARKS In this essay I have attempted to provide an outline of what was generally known about anatomy and physiology of motor systems up to the time Broca presented his first cases of aphemia. By 1860, the motor-sensory dichotomy had reached the basal ganglia and the thalamus, respectively. The cerebral cortex was still not considered to mediate in any direct way motor or sensory stimuli; this took place in the lower centres. Most all investigators felt that the cortex was the seat of the will and the intellect. One hundred years before, the whole medullary mass had been viewed more or less as the cortex was in 1860 (i.e., as a “sensorium commune”—holistic, continuous, and_ indivisible), but the growth of experimental motor-sensory physiology (irritation and/or ablation of structures) parcelled out motor-sensory functions on the way up the neuraxis. Nevertheless, at the level of the cerebrum, the phrenologists were boldly localising functions of a higher sort, with bi-lateral representation in homologous regions of both hemispheres. By 1860, the only remaining structures for the “soul” were in the cerebral convolutions of both hemispheres, but again, the “soul” itself was being threatened by phrenology. Descriptions of aphasia between 1800 and 1860, vindicating many pre-19th- century studies of the phenomenon, demonstrated that speaking and comprehending language could be separately disrupted by brain damage. Words could be “forgotten” as a consequence of a stroke (apoplexy) in paticnts who could nevertheless articulate well, and there had been numerous descriptions of articulatory disorders without loss of the “sense” of words. Since language was considered “‘intellectual’””, however, each separable aspect of language had to have a distinct cortical seat. Thus, the intellectual faculty for memory of the procedures for articulating words was assigned an autonomous role, since that faculty alone could be disturbed. It unwittingly fell to Broca to accept Auburtin’s wager, to take Auburtin to the Salpetrier to judge whether Tan indeed had the requisite aphemic symptomatology, to wait until Tan died (which occurred alarmingly a few days after Auburtin saw him), to have Tan autopsied, which subsequently corroborated involvement of the anterior lobe, and to further suggest a more exact localisation for the speech faculty within the frontal lobe. The lesion, as large as it was, was essentially cortical, at least when the progressive deterioration started years before. Since the hospital staff had reported to Broca that the first symptom they noticed was Tan’s speech disruption. Broca reasoned that the lesioning process must have begun where the deepest depression of the damage looked to be—at the inferior foot of the third frontal convolution. It was a cortical lesion essentially, at least at theLLL TT Tn 808 BUCKINGHAM. outset of the disease some twenty years carlicr, and therefore Broca had no alternative but to suggest that what was interrupted was the memory for articulatory procedure, rather than a direct involvement of the motor processes themselves. The | ensuing few years ultimately led Broca in 1865 to break with the “law of symmetry” | and to finally claim unambiguously that “... nous parlons avec 'hemisphere gauche”. | The rest of the story of Broca’s aphasia can be characterised as a series of efforts to either confirm or deny this specific localization and its unilaterality, or to refine the description of the grammatical, the lexical, the morphological, and the phonetic | aspects of the syndrome. REFERENCES Acckerknecht, E. H. (1958). Contributions of Gall and the phrenologists to knowledge of brain function. In F. H. L, Pointer (Ed.), The history and philosophy of the brain and its functions. Springfield, IL: Charles Thomas. Bastian, H. C. (1869). On the various forms of loss of speech in cerebral disease. British and Foreign | ‘Medical-Chirurgical Review, 43, 209-236, 470-492. Benton, A. L. (1965a). Contributions to aphasia before Broca. Cortex, 1, 314-327. Benton, A. L. (1963b). Gesner on aphasia. Medical History, 9, 54-60. Benton, A. L. (2000). Exploring the history of neuropsychology: Selecied papers. New York: Oxford University Press. Benton, A. L., & Joynt, R. J. (1960). Early descriptions of aphasia. Archives of Neurology, 3, 203-222. Benton, A. L., & Joynt, R. J. (1963). Three pioneers in the study of aphasia Gohann Schmidt, Peter Rommel, Johann Augustin Philipp Gesnes). Journal of the History of Medicine and Allied Sciences, 18, 381-384, Bichat, M. F. X. (1805). Recherches physiologiques sur la vie et la mort Grd ed.). Paris: Brosson/Gabon. Bouillaud, J. B. (1825). Recherches eliniques propres a demonstrer que la perte de la parole correspond & ; la lesion des lobules anterieurs du cerveau. Et & confirmer Popinion de M. Gall sur le séige de Porgane du language articule. Archives Generales de Médécine, 8, 25-45, Buckingham, H.W. (1999). Freud’s continuity thesis. Brain and Language, 69, 76 92 Buckingham, H. W., & Finger, S. (1997), David Hartley's psychobiological associationism and the legacy of Aristotle. Journal of the History of the Neurosciences, 6, 2\-31. Bynum, W. F. (1975). Varieties of Cartesian experience in early nineteenth century neurophysiology. In S. Spiker & T. Englehardt (Eds.), Philosophy and medicine. Vol. II: Philosophical dimensions of the neuromedical sciences. Dordrecht, Holland: D. Reidel, Carmichael, L, (1926). Sir Charles Bell: A contribution to the history of physiological psychology. Psychological Review, 33, 188-217. Christman, S. S., & Boutsen, F. R. (2006). Recovery of language after stroke or trauma in adults. In K. / Brown (Ed.), Encyclopedia of language and linguistics, 2(Vol.14). St. Louis, MO: Elsevier Press. Clarke, E., & Dewhurst, K. (1972). An illustrated history of brain function. Berkeley: University of California Press Clarke, E., & O'Malley, C.D. (1968). The human brain and spinal cord: A historical study. Berkeley: University of California Press. i Critchley, M. (1964). The origins of aphasiology. Scottish Medical Journal, 9, 231-242 Cubelli, R., & Montagna, C. G. (1994). A reappraisal of the controversy of Dax and Broca. Journal of the History of the Neurosciences, 3, 215-226. | Dingwall, W. O. (1975). The species-specificity of speech. In D. P. Dato (Ed.), Georgetown University Roundtable on Languages and Linguistics: Derelopmental psycholinguisties; theory and applications. Washington, DC: Georgetown University Press, Dingwall, W. 0. (1979). The evolution of human communication systems. In H, Whitaker & H., AWhitaker (Eds), Studies in neurolinguisties, Vol. 4. New York: Academic Press. Figlio, K. M. (1975). Theories of perception and the physiology of mind in the late 18th century. History of ‘Setence, 13, 177-212.THE PROBLEM OF BROCA’S APHASIA 809. Finger, S. (1995). Decartes and the pineal gland in animals. A frequent misinterpretation, Journal of the History of the Neurosciences, 4, 166-82. Finger, 8. (2000), Minds behind the brain: A history of the pioneers and their discoveries (Chapter 6: “Rene Decartes: The mind-body problem”. Oxford: Oxford University Press Finger, S., & Buckingham, H. W. (1994). Alexander Crichton (1763-1856): Disorders of fluent speech and associationist theory. Archives of Neurology, 51, 498-503 Finger, $. & Roe, D. (1996). Gustave Dax and the early history of cerebral dominance. Archives of Neurology, 53, 806-813. Finger, S., & Roe, D. (1999). Does Gustave Dax deserve to be forgotten? The Temporal theory and other contributions of an overlooked figure in the history of language and cerebral dominance. Brain and Language, 69, 16-30. Fritsch, G., & Hitzig, E. (1870/1960). On the electrical excitibility of the cerebrum. [Trans. in von Bonin (Ed.), Some papers on the cerebral cortex. Springfield, IL: Charles C. Thomas}, Gall, F. J. & Spurzheim, J. C, (1835). On the functions of the brain and of each of its parts: with observations of the possibility of determining the instincts, propensities, and talents or the moral and intellectual dispositions of men and animals, by the configuration of the brain and head (6 Vols. Trans. Winslow Lewis, Jr.). Boston, MA: Marsh, Capen & Lyon. Hartley, D. (1746/1959). Various conjectures on the perception, motion, and generation of ideas (Trans. R E. A. Palmer, with introduction and notes by Martin Kallich. Reprinted by the Augustan Reprint Society, No. 77-8]. Los Angeles: William Andrews Clark Memorial Library, University of California at Los Angeles. Hartley, D. (1749/1976). Obeservations on man. London: Charles Hitch & Stephen Austen, [Reprinted with introduction by Theodore L. Huguelet, Delmar, NY: Scholars’ Facsimiles & Reprinis} Haymaker, W., & Schiller, F. (1970). The founders of neurology. Springfield, IL: Charles C. Thomas. Head, H. (1926). Aphasia and kindred disorders of speech (2 Vols.). London: Cambridge University Press. Hecaen, H., & Albert, M. L. (1978). Human neuropsychology. New York: John Wiley & Sons. Jacyna, L. 8. (2000). Lost words: Narratives of language and the brain, 1825-1926. Princeton, NJ: Princeton University Pres. Jorgensen, C. B. (2003), Aspects of the history of the nerves: Bell's theory, the Bell-Magendie law and controversy, and two forgotten works by P. W. Lund and D. F. Eschricht. Journal of the History of the Neurosciences, 12, 229-249, Joynt, R. J. (1964). Paul Pierre (sic) Broca: His contribution to the knowledge of aphasia. Cortex, 1, 206-213. Keams, K. P. (2005). Broca’s aphasia In L. L. Lapointe (Ed.), Aphasia and related language disorders (3rd ed.). New York: Thieme, Lieberman, P. (1975). On the origins of language: An introduction t0 the evolution of human speech. New ‘York: Macmillan. Luzzatti, C., & Whitaker, H. A. (2001). Jean-Baptiste Bouillaud, Claude-Francois Lallemand, and the role of the frontal lobe. Archives of Neurology, 58, 1157-1162. Mesulam, M. (1990). Large scale neurocognitive networks and distribution processing for attention, language, and memory. Annals of Neurology, 28, 597-603. Penfield, W., & Roberts, L. (1959). Speech and brain mechanisms. Princeton, NJ: Princeton University Press. Riese, W. (1977), Selected papers on the history of aphasia (R. Hoops, ¥. Lebrun, & E. Buyssens, Fds). Amsterdam & Lisse: Swets & Zeitlinger, B.V. Riese, W.. & Hoff, E. C, (1950). A history of the doctrine of cerebral localization: Sources, anticipations and basic reasoning. Journal of the History of Medicine, 5, 50-71, Roe. D.. & Finger, S. (1996). Gustave Dax and his fight for recognition: An over-looked chapter in the carly history of cerebral dominance. Journal of the History of the Neurosciences, 5, 228-240, Russell, B. (1912). The problem of philosophy. Oxford: Oxford University Press. Schiller. F. (1992). Paul Broca: Founder of French anthropology, explorer of the brain (2nd ed.). Berkeley: University of California Press. Schiller J. (1968). Physiology’s struggle for independence in the first half of the 19th century. History of Science, 7, 64-89. Starr, M.Allen (1889). Aphasia. In Transactions of the Intemational Medical Congress of Physicians and ‘Surgeons (Vol. 1. p. 879). New York: Congress of American Physicians and Surgeons. Stookey, B. (1963), Jean-Baptiste Rouillaud and Ernest Auburtin: Early studies on cerebral localization and the speech center. Journal of the American Medical Association, 184, 1024-1029,810 — BUCKINGHAM ‘Temkin, O. (1953). Remarks on the neurology of Gall and Spurzheim. In E, A. Underwood (E4.), Seience, ‘medicine and history (Yol. I). London: Oxford University Press. von Bonin, G. (Ed), (1960). Some papers on the corebral cortex. Springfield, IL: Charles C. Thomas. Walker, A. E. (1987) Stimulation and ablation: Their role in the history of cerebral physiology. Journal of Neurophysiology, 20, 435-449. Wallace. W. (2003). The vibrating nerve impulse in Newton, Willis and Gassendi: First steps in a mechanical theory of communication, Brain and Cognition, 51, 66-94. Willis, T. (1681/1971). The anaiomy of the brain. Tucahoe, NY: USV Pharmaceutical Corporation. Young, R. M. (1990). Mind, brain and adaptation in the 19th century: Cerebral localization and its biological context from Gall to Ferrier 2nd ed.) Oxford: Oxford University Press. Zimmer, C: (2004). Soul made flesh: The discovery of the brain and how it changed the world. New York: Free Press.