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

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.

A Parisian spring: the debate on language localization at the Imperial Academy of Medicine, Paris, April 4-June 13, 1865.

The localization of articulate language (speech) to the posterior third of the third left frontal convolution-Broca's area-did not occur to Broca as he reported the case of his first aphasic patient in 1861. Initially Broca localized articulate language to both frontal lobes, a position that he maintained for 4 years after publishing his first case. In the interval, the Academy of Medicine in Paris had received a copy of a paper authored in 1836 by Marc Dax, in which Dax claimed that the ability to speak resides within the left hemisphere alone. The Academy of Medicine convened in the spring of 1865 to adjudicate the issue. All of the distinguished speakers argued against Dax's contention by citing the prevailing paradigm, that bilaterally symmetrical organs, such as the eyes and ears, and the hemispheres of the brain, must perform the same function. The lone dissenting voice was that of Jules Baillarger, the discoverer of the laminar organization of the cerebral cortex, whose argument in favor of what he called "Dax's law" was so lucid that it carried the day. During his address to the Academy, Baillarger not only supported left-hemisphere dominance for speech, but for the first time described two forms of aphasia, fluent and nonfluent, now referred to as Wernicke's and Broca's aphasias, respectively, as well as the ability of aphasics to speak during emotional outbursts, to which we now refer as Baillarger-Jackson aphasia. It was 9 days after Baillarger's address that Broca, for the first time, unequivocally localized speech to the left frontal lobe.This paper is based on the author's reading of Dax's and Broca's original texts and of the texts read before the Academy of Medicine meeting held at the National Library of France between April 4, 1865, and June 13, 1865. From these primary sources it is concluded that the Academy of Medicine's debate was the last serious challenge to left-hemisphere dominance for speech and to the localization of articulate language to the left frontal lobe-and that Jules Baillarger played a pivotal role in what was a defining moment in neurobiology.

Fundamental or forgotten? Is Pierre Paul Broca still relevant in modern neuroscience?

The ability to speak is a unique human capacity, but where is it located in our brains? This question is closely connected to the pioneering work of Pierre Paul Broca in the 1860s. Based on post-mortem observations of aphasic patients' brains, Broca located language production in the 3rd convolution of the left frontal lobe and thus reinitiated the localizationist view of brain functions. However, contemporary neuroscience has partially rejected this view in favor of a network-based perspective. This leads to the question, whether Broca's findings are still relevant today. In this mini-review, we discuss current and historical implications of Broca's work by focusing on his original contribution and contrasting it with contemporary knowledge. Borrowing from Broca's famous quote, our review shows that humans indeed "speak with the left hemisphere"- but Broca's area is not the sole "seat of articulatory language".

Dominique Jean Larrey (1766-1842) and His Contributions to Military Medicine and Early Neurosurgery.

Dr. Dominique Jean Larrey was a pioneer in the field of military surgery. His creative innovation and drive to improve the quality of medical services available to those injured during war guided his achievements in medicine. Dr. Larrey has often been referred to as "the father of emergency medical services" and "the father of modern military medicine." His contributions to medicine continue to live on in common procedures and healthcare systems today, such as aspiration of pericardial effusion and drainage of hemothorax and empyema. Based on his own writings, he treated multiple cases of intracranial injury, making him an early, but often forgotten, pioneer of neurosurgery.

Beyond descriptive neurology: Broca, cerebral hemodynamics, and cortical function.

Pierre-Paul Broca's studies in neurobiology remain of interest. I review a previously neglected aspect of Broca's work in which he presages the use of modern scanning techniques. Broca's goal was to correlate cerebral metabolism to regional cerebral blood flow (CBF) using a novel method, to which he referred as cerebral thermometry. Broca attempted to measure changes in temperatures from the ischemic area and across the watershed regions during a stroke, and the increased CBF produced by performing a cognitive task such as reading aloud. The method involved measurements of local temperatures at specific points about the head with an array of strategically placed thermometers much as EEG electrodes are arrayed to record the electrical activity of the brain. Although his technique was inaccurate and unreliable, the concept of measuring CBF as a diagnostic aid and as a cognitive research tool was prescient. Broca's limitation was not conceptual but purely technological. Broca's attempt to measure CBF as a surrogate for cerebral metabolism was conceptually valid but premature because he lacked the technology necessary to do so.

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'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.

Between Bouillaud and Broca: An unknown Italian debate on cerebral localization of language.

From 1825 onward, Bouillaud began gathering clinical evidence to support the hypothesis that speech is located in the cerebral frontal lobes. His aim was to provide empirical proof to Gall's theory of a specific substratum of speech in the anterior region of the brain. A well-known discussion ensued inside the French school among supporters and detractors that went far beyond Broca's first report in 1861. Unknown is that Bouillaud's investigations on localization of articulated language also gave rise to a discussion in Italy in the same period. In particular, speech localization formed a central topic in the mid-19th century in Northern Italy mainly thanks to four physicians, Michelangelo Asson, Mosè Rizzi, Gaetano Strambio and Filippo Lussana, who reported on language-impaired patients and approached these cases in the light of Bouillaud's claims. Similarly to the French debate, the Italian medical community also included attacks and advocacies of the hypothesis of a precise localization of articulated language in the frontal lobes. However, they were mainly interested in investigating the anatomo-clinical relationships rather than in supporting Gall's organology. This Italian debate appears to be the first to have developed in the mid-19th century outside that of the French community.

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.

Mysterious "Monsieur Leborgne": The mystery of the famous patient in the history of neuropsychology is explained.

As of spring 2011, 150 years have passed since the death of one of the most famous neurological patients of the nineteenth century. A Frenchman, "Monsieur Leborgne" also known by the nickname "Tan," was hospitalized due to an almost complete loss of speech. His case was presented in 1861, during a seating of the Société d'Anthropologie de Paris by a physician, Pierre Paul Broca (1824-1880), who used this occasion to report that he had discovered, in the middle part of patient's left frontal lobe, the cortical speech center. This area was later named "Broca's area." Both the patient and his medical records were the subject of numerous descriptions and citations in the medical literature. The patient's full identity and social background has remained a mystery until now. This article presents biographical data concerning Leborgne and his family based on archive registers in France.

Revisiting the contributions of Paul Broca to the study of aphasia.

There are few iconic publications in the annals of clinical neuroscience that have had the impact of Paul Broca's 1861 paper that appeared in the Bulletin de la Société Anatomique Broca (Bulletin Society Anatomique, 6:330-357, 1861). It was, however, by no means his last word on the matter of language localization, specifically, or on the overarching principle of regional specialization of brain function. Thus we comment on English translations of two of his works: the original paper and another from 1865. Although the 1861 paper has received the most credit, his manuscript 4 years later and based on a much larger case series was the first to state based on empirical observation that the left frontal region was responsible for articulated speech. Moreover, his observations of aphasia recovery reported in this later work led to his own hypotheses on the importance of cerebral reorganization after injury and to the differences in reacquisition of adult language vis-à-vis the nature of initial language development that were verified a century later. He also proposed a method of language remediation whose efficacy was not established for another 100 years. Thus Broca's contributions to the contemporary study of aphasia reach far beyond his initial case presentation.

Re-examining Paul Broca's initial presentation of M. Leborgne: understanding the impetus for brain and language research.

The 150th anniversary affords an opportunity to revisit the circumstances surrounding Paul Broca's case report celebrated today as the moment of discovery of aphasia. The proceedings from January to June 1861 of the Paris Society of Anthropology are examined to reconstruct the events surrounding the report of M. Leborgne on April 18th. From a close reading of the presentations and discussions which took place during this period it is apparent that Broca's case report was a minor diversion to a debate about cranial measurements and their relation to intelligence in individuals and racial groups. Moreover, it appears that little attention was granted to Broca's first case at the time. While his ideas about localization and specialization developed and change over the next decade, it represented a minor field of interest for him. Nevertheless Broca's work on aphasia inspired research throughout Europe and North America and went on to have a lasting impact on both aphasiology and neuropsychology.

Broca's area: rethinking classical concepts from a neuroscience perspective.

Just about one and one-half centuries ago, Paul Broca identified the posterior third left frontal convolution of the human brain as a critical area for speech production. Although years of cerebrovascular accident localization studies partially confirmed Broca's claim, recent years have seen a clarification and expansion of the role Broca's area plays in serial processing of language and speech as well as a probable role in nonlinguistic processing. This article will review some of the more recent anatomical and physiological research, including lesion studies, imaging research, and interoperative electrocortical stimulation studies. The article will summarize the research on the role of the human inferior frontal gyrus in lexical, phonologic, and grammatical production, the so-called "mirror mechanism" and other aspects of cognitive processing and motor execution.

Broca's aphasiacs.

After Gall, Bouillaud and Auburtin had localized the function of language to the frontal lobes in the early 19th century, Paul Broca's famous patient, M. Leborgne (known as 'Tan'), was described to the Anthropological Society of Paris and his case was published in the Bulletin de la Société Anatomique, in 1861. Broca relied on the uncut brain for his clinicopathological inferences. A few months later, his second case, M. Lelong, yielded similar pathological details and confirmed Broca's localization of language. The subsequent controversies with Dax and Pierre Marie are summarized. More recent imaging of the brains of Lelong and Leborgne has partly vindicated Broca's controversial conclusions. Most papers on Broca's work contain only brief, derivative references to his 1861 paper; the actual contents, translated into English, are reproduced here.

[Neurology of cognition and language in the publications of Kálmán Sántha and today]. / A gondolkodás és a beszéd neurológiája Sántha Kálmán közleményeiben és ma.

Based on histopathological investigation of the brain of exceptionally talented persons Sántha found increased volume of parietal association areas with abundance of cells. He supposed that the angular gyrus may be a "memory field". In his publication Genius and inheritance he expressed that: "Talent is a child of the present, but the genius is born for eternity." He discussed the localization of sensory and motor amnestic aphasia analysing the signs of patient with brain tumor and called attention to concomitant psychological symptoms. He found crossed aphasia in twice as many lefthanded than righthanded persons. This may explain the recent observations that the restitution of aphasia is predetermined; speech ability of ambidexterous or latent lefthanded persons improve better. He analysed the topography of emotional and voluntary facial palsy. The currently accepted hierarchical concept of mental and speech ability can be derived from the ouevre of Sántha and his predecessors. Sántha can be honoured as a forerunner of the modern theories of aphasia localization.