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Classics in the History of Psychology An internet resource developed by Christopher D. Green York University, Toronto, Ontario (Return to Classics index) Loss of Speech, Chronic Softening and Partial Destruction of the Anterior Left Lobe of the Brain Pierre Paul Broca (1861) First published in Bulletin de la Société Anthropologique, 2, 235-238 Translation by Christopher D. Green [1] © Christopher D. Green 1999, 2003 All rights reserved. Trans. revised 3 October 2003. (go to French original) Mr. Broca, on the occasion of this report, presented the brain of a fifty-one-year-old man who died in his care at Bicêtre hospital, and who had lost the use of speech for the past twenty-one. As the specimen is to be deposited at the Dupuytren museum, and the complete report is to be published in the Bulletin de la Société anatomique, we restrict ourselves to giving here a short summary of the case, which is quite similar to some of those given by Mr. Auburtin at the last meeting. When the patient was admitted to Bicêtre, at the age of 21, he had lost, for a some time, the use of speech; he could no longer pronounce more than a single syllable, which he ordinarily repeated twice at a time; whenever a question was asked of him, he [p. 236] would always reply tan, tan, in conjunction with quite varied expressive gestures. For this reason, throughout the hospital, he was known only by the name of Tan. At the time of his admission, Tan was perfectly able-bodied and intelligent. After about 10 years, he began to lose the movement of his right arm, then the paralysis spread to the lower limb of the same side, so much so that, for six or seven years, he continually stayed in bed. For some time it has been reported that his sight was weakening. Finally, those who have had a particularly close relationship with him have remarked that his intelligence has dropped off a lot in recent years. April 12, 1861, he was transferred to the care of hospital surgery for an immense, widespread gangrenous inflammation [phlegmon], which affected the full extent of the right lower limb (the paralysed side), from the heel up to the buttock. It was then that Mr. Broca saw him for the first time. The study of this unfortunate, who could not speak and who, being paralysed in the right hand, could not write, presented some difficulty. It was noted, however, that general sensation was maintained; that the left arm and leg obeyed the will; that the muscles of the face and of the tongue were at no point paralysed, and that the movements of this last organ were perfectly free. The state of intelligence could not be exactly determined, but there is evidence that Tan understood almost everything that was said to him. Not able to express his ideas or his desires other than by the movement of his left hand, he often made incomprehensible gestures. The numerical responses were the ones he made best, by opening or closing his fingers. He would indicate, without error, the time on a watch to the second. He knew exactly how many years he had been in Bicêtre, etc. [p. 237] However, many questions to which a man of normal intelligence would have found the means to respond by gesture, remained without intelligible response; other time the response was clear, but did not answer the question. Undoubtedly, then, the intelligence of the patient had been affected to a great degree [atteinte profonde], but he maintained certainly more of it than was needed for talking. The patient died April 17, 1861. At the autopsy, the dura mater was found to be thickened and vascularised, covered on the inside with a thick pseudo-membranous layer; the pia mater thick, opaque, and adherent to the anterior lobes particularly the left lobe. The frontal lobe of the left hemisphere was soft over a great part of its extent; the convolutions of the orbital region, although atrophied, preserved their shape; most of the other frontal convolutions were entirely destroyed. The result of this destruction of the cerebral substance was a large cavity, capable of holding a chicken egg, and filled with serous fluid. The softness had spread up to the ascending fold of the parietal lobe, and down to the marginal fold of the temporal-sphenoidal lobe; finally, in the depths, [it spread to] the region of the insula and the extraventricular nucleus of the striate body; it was the lesion of this last organ which was responsible for the paralysis of the movement of the two limbs of the right side. However, it suffices to cast a glance at this paper to recall that the principal home and the original [primitif] seat of the softness, is the middle part of the frontal lobe of the left hemisphere; it is there than one find the most extensive lesions -- the most advanced and the oldest. The softness progressed very slowly to the adjoining parts and one can regard it as certain that it was there for a very long period. [p. 238] during which the illness did not affect the convolutions of the frontal lobe. This period probably corresponds to the eleven years that preceded the paralysis of the right arm, and during which the patient had maintained his intelligence, having lost nothing other than speech. All this permits, however, the belief that, in the present case, the lesion of the frontal lobe was the cause of the loss of speech. [1] Many thanks to Ola Selnes (Johns Hopkins U.) and Josée Rivest (York U.) for their helpful comments and suggestions. The responsibility for any errors is, of course, my own. -CDG- http://www.livescience.com/26599-famous-brain-injury-patient-identified.html In 1840, a wordless patient was admitted to the Bicêtre Hospital outside Paris for aphasia, or an inability to speak. He was essentially just kept there, slowly deteriorating. It wasn’t until 1861 that the man, who came to be known as Monsieur Leborgne, or "Tan," for his only spoken word, came to the famous physician Paul Broca’s ward at the hospital. Shortly after the meeting, Leborgne died, and Broca performed his autopsy. During the autopsy, Broca found a lesion in a region of the brain tucked back and up behind the eyes. Paradigm shift After doing a detailed examination, Broca concluded that Tan’s aphasia was caused by damage to this region, and that the particular brain region controlled speech. That region of the brain was later renamed Broca’s area in honor of the doctor. [See Photos of Broca’s Brain] At the time, scientists were debating whether specific areas of the brain performed specific functions, or whether it was an undifferentiated lump that did one task, like the liver, said Marjorie Lorch, a neurolinguist at Birkbeck, University of London, who was not involved in the study. "Tan was the first patient whose case proved that damage to a specific part of the brain causes specific speech disorders," said study author Cezary Domanski, a medical historian at the Maria Curie-Sklodowska University in Poland. Life reconstructed Yet Tan’s identity remained shrouded in mystery. Most historians believed he was a poor, illiterate laborer, while others said he had gone mad from syphilis and that madness could explain his inability to speak. To discover just who he was, Domanski began to retrace the man’s history. "It was a challenge, for 150 years no one could even determine the name of the man —the same man whose brain is exhibited in a museum and shown in many books," Domanski wrote in an email. But looking through the old medical records, he finally uncovered a death certificate for Louis Victor Leborgne, who was born in 1809 in Moret, France. Domanski then used archival records to discover that Louis Leborgne was one of seven children of a teacher (his father) and his wife, and that his siblings were educated. He moved to Paris as a child. Leborgne had apparently suffered epilepsy from childhood. But despite his seizures, he grew up to be a craftsman and a church keeper, and worked there until he was 30 years old, when he lost the ability to speak and was taken to the hospital. Epilepsy likely caused the damage that took away Leborgne’s power of speech. [The 10 Greatest Mysteries of the Mind] In the hospital, his condition worsened and he eventually became paralyzed and bedridden, and underwent surgery for gangrene. He was dying when Broca first encountered him. The new discovery gives a very human identity to one of the medical textbooks’ most famous cases, Lorch told LiveScience. "Language, because it was viewed at that time in Europe as a God-given ability in humans, it was considered part of the soul and therefore not material," Lorch said. "This case was the case that really established the whole area of research on functional organization of the brain."