Localização cerebral de funções superiores: o período entre Thomas Willis e Paul Broca

Engelhardt, Eliasz

doi:10.1590/1980-57642018dn13-020014

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History Note • Dement. neuropsychol. 13 (2) • Apr-Jun 2019 • https://doi.org/10.1590/1980-57642018dn13-020014 copiar

Localização cerebral de funções superiores: o período entre Thomas Willis e Paul Broca

Autoria SCIMAGO INSTITUTIONS RANKINGS

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).

Palavras-chave:
função nervosa superior; Willis; Broca; afemia; fala; linguagem; assimetria hemisférica

Author

Function and localization

Thomas Willis
(1621-1675)
English physician and anatomist

Willis grounded his theories on his anatomical studies and clinicopathological cases³3 Willis T. Cerebri anatome, cui accessit nervorum descriptio et usus. London: Jo. Martyn & Ja. Allestry, 1664.^,⁴4 Willis T. De anima brutorum, quae hominis vitalis ac sensitiua est, exercitationes duae. Leyden: Joannis Antonii Huguetan & Soc, 1676.. He explained: ‘…some functions belong to its substance [of the brain]…amongst these…imagination, memory and appetite...”. Then: ‘…the ‘memory act’ (memmoriae actus) consists of regurgitation of the spirit from the outer surface of the brain [cerebral cortex]…” . He reinforced the cortical localization of memory with the manner of its acquisition (for auditory information): ‘…thence this impression spreads further, and brings to the brain the item (feature)…and leaves in the cortex its image or a private mark for the memory …”, and regarding remembrance (for vision): ‘…a sensory impression, like the optical forms… agitates the cortex of the brain…the sensible objects are impressed as icons (images) or characters, and when later reflected back from thence, revive the memory of the same thing” (1664)³3 Willis T. Cerebri anatome, cui accessit nervorum descriptio et usus. London: Jo. Martyn & Ja. Allestry, 1664.. It is noteworthy that Willis named and described several brain structures, and the arterial circle of the base, named after him; he created the term ‘neurology’ (νευρολογία [neurologia – in Greek) to designate the study of peripheral nerves, later extended to denote the speciality³3 Willis T. Cerebri anatome, cui accessit nervorum descriptio et usus. London: Jo. Martyn & Ja. Allestry, 1664..

Pierre-Paul Broca
(1824-1880)
French physician and anthropologist

Broca studied patients with speech loss (1861-1865) - his two initial cases, Leborgne (Tan) and Lelong, were examined in life, and their condition was named ‘aphemia” (aphèmie) (1861); their post-mortem examinations of the brain revealed, in both cases, a lesion to an area in the left frontal lobe. Further cases provided confirmation of this finding, and he was able to conclude: ‘…the site of production of the articulate language (speech) (langage articulé) was localized… in the posterior part of the 3^rd frontal circumvolution of the left hemisphere, and that a lesion there resulted in aphemia” ^5,6,7. He also recognized a functional difference between the hemispheres, and for speech, he stated: ‘...we speak with the left hemisphere” (...nous parlons avec l’hèmisphère gauche) (1865)⁶6 Broca P. Remarques sur le siège, le diagnostic et la nature de l'aphémie. Bulletins de la Société Anatomique, 1863. [Retrieved from: gallica.bnf.fr / Bibliothèque nationale de France]
gallica.bnf.fr... .It should be highlighted that Broca’s study on speech may be regarded as a foundation stone for aphasiology.

Author	Function and localization
Emanuel Swedenborg (1638-1772) Swedish scientist and philosopher	Swedenborg considered that: ‘The [surface of the] cerebrum is made up…discrete cortical parts… designated ‘sphaerulae’ or ‘cerebellula’…related to each sense and other functions… thus permitting the cerebrum to perform at the same time, and yet distinctly, so many different tasks”⁹9 Swedenborg E. The Brain, considered anatomically, physiologically and philosophically. Trans. and ed. by RL Tafel. Vol 1: The Cerebrum and its Parts. London: Spiers, 1882.. Concerning the seat of the intellect [higher functions]…he affirmed: ‘…the ‘anterior province’ of the cerebrum (highest lobe)[frontal lobe] is more important than the posterior”, and explained: ‘If this portion of the cerebrum is damaged, than the internal senses – imagination, memory, thought – suffer; the very will is weakened, and the power of determination is blunted. This is not the case if the injury is to the back part of the cerebrum” (1741)⁹9 Swedenborg E. The Brain, considered anatomically, physiologically and philosophically. Trans. and ed. by RL Tafel. Vol 1: The Cerebrum and its Parts. London: Spiers, 1882..
Jiri (Georg) Prochaska (1749-1820) Czech anatomist and histologist	Prochaska, regarding the so-called higher functions, stated: ‘…since the brain…is composed of many parts, variously featured, it is probable, that nature…has dedicated these parts to various uses…the various ‘cogitating (intellectual) parts’ [faculties] (diversae cogitationis partes) seem to require different portions of the cerebrum…by no means improbable, that each division of the intellect [higher nervous functions] has its allotted organs, so that there is one for the perceptions, another for the understanding, probably others for the will, and imagination, and memory…”¹¹11 Chvátal A. Jirí Procháska (1749-1820): Part 2: "De structura nervorum" - Studies on a Structure of the Nervous System. J Hist Neurosci. 2015; 24:1-25.^,¹²12 Prochaska G. De structura nervorum. Tractatus anatomicus. Vindobonae: Rudolphum Graeffer. 1779..
Franz Joseph Gall (1758-1828) German physician and anatomist	Gall, in the initial outline of his theory, wrote: ‘…the faculties and propensities of man have their seat in the brain…the faculties among themselves, and the propensities among themselves, are essentially distinct and independent - they ought, consequently, to have their seat in parts of the brain distinct and independent of each other” (1798)¹³13 Gall FJ. Schreiben über seinen bereits geendigten Prodromus über die Verichtungen des Gehirns der Menschen und der Thiere an Herrn Jos F von Retzer [Letter upon the Functions of the Brain, in Man and Animals to Mr. Joseph F von Retzer]. Der neue Teutsche Merkur 1798; 3: 311-32.. He proposed that the brain possess 27 basic functions or ‘mental faculties’…associated to ‘organs’ [hypothetic cortical modules], distinguished by their functional strength (power), the real representative of the faculties, topographically localized on the brain surface [cerebral cortex]. The intellectual faculties (e.g., memory [words (verbal), things, facts (events), places (spatial), persons, numbers], senses [order, language (speech), places (spatial orientation), relation of numbers, persons) were localized in relation to the frontal bone, i.e., in the anterior [frontal] region (1810-1819)¹⁴14 Gall FJ, Spurzheim JG. Anatomie et physiologie du système nerveux en général et du cerveau en particulier, avec des observations sur la possibilité de reconnaître plusieurs dispositions intellectuelles et morales de l'homme et des animaux par la configuration de leurs têtes. Paris: Chez F. Schoell, 1810-9..

Author	Function and localization
Johannes Jakob Wepfer (1620-1695) Swiss physician and pharmacologist	Wepfer explained that clinical manifestations in apoplexy should be seen as resultant from lesion of the brain parenchyma (causa medullosa), abandoning the ‘ventricular theory’ (1658) ¹⁷17 Wepfer JJ. Observationes Anatomicae, ex cadaveribus eorum, quos sustulit Apoplexia. Cum exercitatione de eius loco affecto. Schaffhausen: Johann Caspar Suter, 1658.^,¹⁸18 Wepfer JJ. Observationes Medico-Practicae, de affectionibus capitis internis et externis. Wepfer B, Wepfer GM eds. Schaffhausen: Johann Adam Ziegler, 1727.. He described numerous cases, at least 13 with speech disorders (aphasic type), with right hemiplegia, published posthumously by his nephews (nepotum) Bernhard and Georg Michael Wepfer (1727)¹⁷17 Wepfer JJ. Observationes Anatomicae, ex cadaveribus eorum, quos sustulit Apoplexia. Cum exercitatione de eius loco affecto. Schaffhausen: Johann Caspar Suter, 1658.^,¹⁹19 Luzzatti C. Osservazioni Cliniche Ed Anatomiche Nella Storia Della Neuropsicologia Del Linguaggio: Gli Studi Pre-Broca. Riv Int Filosof Psicol. 2013;4(2):116-33...Illustrative post-apoplexia [vascular] case (n^o. CLXVII) (1692): ‘…after headache…acute right hemiplegia, and loss of speech…partial recovery of movements… speech limitation, uttering only the word ‘Yes’ (Ja), able to see and recognize, unable to read…”, he identified as ‘right hemiplegia with speech loss’ (hemiplegia lateris dextri cum loquelae abolitione)¹⁷17 Wepfer JJ. Observationes Anatomicae, ex cadaveribus eorum, quos sustulit Apoplexia. Cum exercitatione de eius loco affecto. Schaffhausen: Johann Caspar Suter, 1658.^,¹⁹19 Luzzatti C. Osservazioni Cliniche Ed Anatomiche Nella Storia Della Neuropsicologia Del Linguaggio: Gli Studi Pre-Broca. Riv Int Filosof Psicol. 2013;4(2):116-33..Illustrative post-traumatic case (n^o. XVII) (1680): ‘...left bregmatic [frontoparietal] trauma…penetrating …causing a lesion of the brain substance…later almost speechless, uttering not more than affirmative or negative monosyllables, the right arm being paralyzed…”¹⁷17 Wepfer JJ. Observationes Anatomicae, ex cadaveribus eorum, quos sustulit Apoplexia. Cum exercitatione de eius loco affecto. Schaffhausen: Johann Caspar Suter, 1658.^,¹⁹19 Luzzatti C. Osservazioni Cliniche Ed Anatomiche Nella Storia Della Neuropsicologia Del Linguaggio: Gli Studi Pre-Broca. Riv Int Filosof Psicol. 2013;4(2):116-33..
Antonio Maria Valsalva (1666-1723) Italian physician	Valsalva stated: ‘...those afflicted by apoplexy, where one half of the body is paralyzed, the lesion occurred in the brain on the other side...”, regarding a patient who suffered an apoplexy. He affirmed that this ‘rule’ was confirmed by many autopsied cases (1707)²⁰20 Valsalva AM. De Aure Humana Tractatus. Trajecti ad Rhenum: Ex Officina Guilielmi vande Water, 1707., published posthumously by Morgagni (1761). Many presented single-side paralysis (mostly right, and less left), with lesion contralateral to the hemiplegia, some with speech disorders [a few with possible aphasia] (mostly with right-side paralysis, and a few with left); on autopsy: intraventricular blood or serosity, serosity [ischemia] or blood [hemorrhage] over the hemisphere, lesion of the striatum, and/or thalamus²¹21 Morgagni GB. De sedibus et causis morborum per anatomen indagatis. Libri Quinque. Tomus I. Venetiis: Typographia Remondiniana, 1761. [Retrieved from: https://archive.org/details/texts] https://archive.org/details/texts... ^,²²22 Morgagni GB. The Seats and Causes of Diseases Investigated by Anatomy. [trans William Cooke (1762)]. Vol I. Boston: Wells and Lilly, 1824. [Retrieved from: https://archive.org/details/texts] https://archive.org/details/texts... . Illustrative case VZ (1700): ‘…motor weakness on the right side, next loss of speech… right side became motionless [right hemiplegia]…aphonia improved, but speech was unintelligible and the words uttered with effort and a low voice”; on autopsy: ‘…fluid on the hemispheres, more on the right side (serous apoplexy)” [ischemic apoplexy] ²¹21 Morgagni GB. De sedibus et causis morborum per anatomen indagatis. Libri Quinque. Tomus I. Venetiis: Typographia Remondiniana, 1761. [Retrieved from: https://archive.org/details/texts] https://archive.org/details/texts... ^,²²22 Morgagni GB. The Seats and Causes of Diseases Investigated by Anatomy. [trans William Cooke (1762)]. Vol I. Boston: Wells and Lilly, 1824. [Retrieved from: https://archive.org/details/texts] https://archive.org/details/texts... .
François Pourfour du Petit (1664-1741) French physician and anatomist	Pourfour du Petit examined five soldiers with traumatic head injuries, and limb paralysis opposite to the brain lesion, and later autopsied. He also found, on dissection, crossing fibers at the level of the pyramidal bodies (corps pyramidal) [pyramids] [medulla oblongata] as the anatomical substrate for this finding²⁴24 Pourfour du Petit F. Lettres d'un médecin des hôpitaux du Roy [F. Pourfour Du Petit] à un autre médecin de ses amis. Namur: Charles Gerard Albert, 1710, pp 1-16. [Retrieved from: gallica.bnf.fr / Bibliothèque nationale de France] gallica.bnf.fr... . One of the cases also presented a speech disorder: ‘…on examination presented right hemiplegia… could not pronounce (utter) anything other than ‘No’ (…mais il ne pouvoit prononcer autre chose que Non)…judgement was always very sound during the illness…”; on autopsy: ‘…in the left side, the entire anterior protuberance [frontal lobe] including the…‘fluted bodies’ (corps cannelez) [corpus striatum] [and surrounding structures], was completely dissolved and reduced to a substance similar to wine lees…” (1710)²⁴24 Pourfour du Petit F. Lettres d'un médecin des hôpitaux du Roy [F. Pourfour Du Petit] à un autre médecin de ses amis. Namur: Charles Gerard Albert, 1710, pp 1-16. [Retrieved from: gallica.bnf.fr / Bibliothèque nationale de France] gallica.bnf.fr... .
Giovanni Battista Morgagni (1682-1771) Italian physician	Morgagni grouped his own cases together with those of Valsalva and friends, all with hemiplegia, mostly right (some left) and contralateral brain lesions; some presented speech disturbances [a few could be identified as possible aphasia] (most with right-side paralysis, and a few with left-side); on autopsy: intraventricular blood or serosity, serosity [ischemia] or blood [hemorrhage] over the hemisphere, lesion of the striatum, and/or thalamus (1761)²¹21 Morgagni GB. De sedibus et causis morborum per anatomen indagatis. Libri Quinque. Tomus I. Venetiis: Typographia Remondiniana, 1761. [Retrieved from: https://archive.org/details/texts] https://archive.org/details/texts... ^,²²22 Morgagni GB. The Seats and Causes of Diseases Investigated by Anatomy. [trans William Cooke (1762)]. Vol I. Boston: Wells and Lilly, 1824. [Retrieved from: https://archive.org/details/texts] https://archive.org/details/texts... . He affirmed: ‘…the dogma of Valsalva is confirmed…where a paralysis was observed on the left, a defect in the brain was found on the right…”²²22 Morgagni GB. The Seats and Causes of Diseases Investigated by Anatomy. [trans William Cooke (1762)]. Vol I. Boston: Wells and Lilly, 1824. [Retrieved from: https://archive.org/details/texts] https://archive.org/details/texts... ^,²³23 Mistichelli D. Trattato dell'apoplessia in cui con nuove osservazioni anatomiche, e riflessioni fisiche si ricercano tutte le cagioni, e spezie di quel male, e vi si palesa fra gli altri un nuovo, & efficace rimedio. Roma: Antonio de' Rossi alla Piazza di Ceri, 1709. [Retrieved from: https://archive.org/details/texts] https://archive.org/details/texts... .Illustrative case: ‘…sudden right hemiplegia…scarce and babbling speech, replied with gestures when questioned, internal reasoning and understanding preserved…”; on autopsy: ‘…gelatinous material on the left side of the brain, two places eroded…the striated body, affected by the erosion…separated from the rest of the brain…”²¹21 Morgagni GB. De sedibus et causis morborum per anatomen indagatis. Libri Quinque. Tomus I. Venetiis: Typographia Remondiniana, 1761. [Retrieved from: https://archive.org/details/texts] https://archive.org/details/texts... ^,²²22 Morgagni GB. The Seats and Causes of Diseases Investigated by Anatomy. [trans William Cooke (1762)]. Vol I. Boston: Wells and Lilly, 1824. [Retrieved from: https://archive.org/details/texts] https://archive.org/details/texts... .
Jean-Baptiste Bouillaud (1796-1881) French physician	Bouillaud initially observed cases presenting loss of speech, preserved understanding, and expression through writing or gestures, with lesion of the anterior lobe of the brain [without mentioning the side] on autopsy. He then presented cases with speech disorders, lesion of the anterior lobe (left [2] and right [1]) [no limb paralysis mentioned]. He also collected cases from other authors (Lallemand and Rostan), including cases with lesions to left (mostly), right or both anterior lobes (1825)^19,25,26,27. Proposed the existence of a center related to speech function localized in the anterior lobes (lobules antériores) [frontal lobes] of the brain, the ‘legislator organ of speech” (organe législateur de la parole) (1825)²⁵25 Bouillaud MJ. Recherches cliniques propres à démontrer que la perte de la parole correspond à la lésion des lobules antérieurs du cerveau, et à con-firmer l'opinion de M. Gall, sur le siège de l'organe du langage articulé. Arch Gén Méd 1825;8(3):25-45. [Retrieved from: http://www.biusante.parisdescartes.fr/histmed/medica] http://www.biusante.parisdescartes.fr/hi... ^,²⁶26 Bouilaud MJ. Traité clinique et physiologique de l'encéphalite: ou inflammation du cerveau, et de ses suítes. Paris: JB Baillière, 1825. [Retrieved from: http://books.google.com] http://books.google.com... ..
Marc Dax (1770-1837) French physician	Dax presented [allegedly] a report (1836), published posthumously (1865), on three patients with loss of ‘memory for words’ (one maintaining the ‘memory for objects”), one after a left parietal head injury, another after an apoplexy, with a lesion on the left brain surface on autopsy, and a third with ‘forgetfulness of words’, without anatomical definition. He believed that this pattern could be a ‘general rule’. However, he felt that these cases were insufficient and also respected the functional symmetry of the hemispheres doctrine (Bichat’s). After 3 other similar cases, and collecting about 80 more, without exception to the ‘rule’, he concluded: ‘…I believe…that not all diseases of the left hemisphere must impair the ‘memory for words’ [aphasia], but that, when this kind of memory is impaired by an illness of the brain, it is necessary to look for the cause of the disorder in the left hemisphere…”. He inquired: ‘...how is it that changes in the left cerebral hemisphere are followed by forgetfulness of words, while those in the right hemisphere are not?” (...d’où vient que les altérations de l’hémisphère cérébral gauche sont suivies de l’oubli des mots, à l’exclusion de celles de l’hémisphère droit?) ([1836]1865)²⁹29 Dax, M. Lésions de la moitié gauche de l'encéphale coïncident avec l'oubli des signes de la pensée (lu à Montpellier en 1836) et Dax G. Note sur le même sujet. Gaz Heb Med Chir. 1865;17:259-60, 260-2..

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