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 (no. 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 (no. 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.. |