Pierre Paul Broca

The 19th century French surgeon Pierre Paul Broca left an indelible mark in medicine with his observations on aphasia, language dominance, and cerebral localization. Broca is also remembered for his contributions to anthropology, which include valuable studies of human skulls and the founding of the Société d'Anthropologie.Broca (1824–1880) was born at Sainte-Foy-la-Grande near Bordeaux, France, on July 28, 1824. He was educated in Bordeaux and Paris, and received his medical degree in 1848. Broca's remarkable career would revolve around 2 lasting interests—medicine and anthropology. He excelled in both, as a professor of surgery at the Bicêtre in Paris and as a noted anthropologist dealing with a plethora of subjects, including the Cro-Magnon man and Neolithic trephination. Broca also founded the world's first anthropological society and his own school and institute of anthropology.The first cortical localization that became widely accepted linked fluent, articulate speech to the frontal lobes. Cortical localization of speech was a much-debated issue in the early and mid-19th century, and many scientists had presented data for and against this theory before Broca's epoch presentation in 1861. In the early part of the 19th century, Franz Joseph Gall addressed the issue of localization of speech to a specific area of the brain. Gall placed the faculty of memory of words in the frontal lobes, based primarily on his observation of skull shape. Jean Baptiste Bouillaud also believed in the localization of speech to the frontal region. In 1836, Marc Dax suggested that speech disturbances were due to lesions of the left hemisphere, but his hypothesis remained unknown for 30 years until his son, Gustave Dax, presented his father's work in 1863 and published it in 1865.Broca's concepts on speech localization were initially based on the study of a single patient, Monsieur Leborgne, who was affected by epilepsy and who had lost the ability to speak. Leborgne was able to comprehend and communicate by gestures, but his speech was limited to the monosyllable “tan,” and he thus came to be nicknamed “Tan.” Tan also had right hemiparesis. On April 11, 1861, Tan was admitted to Broca's surgical service for cellulitis of the right leg. He was examined also by Ernest Auburtin, Bouillaud's son-in-law. Auburtin was also involved in the debate on cerebral localization.Tan died on April 17, 1861. The next day, Broca presented the autopsy findings before the Anthropological Society of Paris and suggested that softening of Tan's brain in the third left frontal convolution was responsible for his speech disturbance. Broca kept the brain specimen intact without sectioning and presented his findings to the Anatomical Society of Paris in August 1861.In November 1861, Broca presented a second case with a circumscribed lesion in the left third frontal convolution, which was named “Broca's convolution” by David Ferrier. The patient, Monsieur Lelong, was admitted to the Bicêtre 8 years previously at age 76 years for senile debility. In April 1860, he had suddenly become unconscious, and although he partly recovered, he remained aphasic. In October 1861, the patient suffered a fracture of the femur in a fall and was transferred to the surgical service, where he died 12 days later. At autopsy, Broca found a lesion in the second and third frontal convolution, reinforcing his ideas about cerebral localization.Broca called this speech disturbance “aphémie,” which was renamed by Armand Trousseau as “aphasia.” Broca also described another form of speech disturbance, which he called “verbal amnesia,” characterized by a loss of memory for spoken and written words. In 1863, Broca described several patients with aphémie who had lesions of the left hemisphere and pathologic involvement of the third left frontal convolution. In his publication of 1865, Broca took a firm position on left hemispheric dominance for language.Posthumously, Pierre Marie challenged Broca's findings. Marie examined Tan's brain and argued that the lesion was not limited to the frontal lobe, but also involved the parietotemporal region.In 1871, Broca treated a man who suffered a scalp wound after a kick to the head by a horse. The patient developed erysipelas 2 weeks after the incident. This was followed by a nonfluent aphasia about a month after the injury, and the patient became progressively more obtunded and comatose. Broca suspected an abscess and believed that the process began in the posterior aspect of the third left frontal gyrus. He thus performed a craniotomy based on cerebral localization and positioned his craniotomy at this site. He drained an abscess, but the patient died a few days later. Autopsy revealed a left-sided, predominantly frontal, purulent meningoencephalitis.Broca was a prolific writer, and his publications included a classic monograph on aneurysms. In the course of his comparative studies of the mammalian brain, Broca identified the limbic lobe. His name is also attached to the diagonal band of Broca.Broca is rightfully credited with describing what is now known as Broca aphasia. A respected scientist, physician, anthropologist, and statesman, Pierre Paul Broca died suddenly in the prime of his life at the age of 56.

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