Commentary A Tale of Two Brains – Cortical localization and neurophysiology in the 19th and 20th century Philippe-Antoine Bilodeau, MDCM(c)1 MJM 2018 16(5) Abstract Introduction: Others have described the importance of experimental physiology in the development of the brain sciences and the individual discoveries by the founding fathers of modern neurology. This paper instead discusses the birth of neurological sciences in the 19th and 20th century and their epistemological origins. Discussion: In the span of two hundred years, two different conceptions of the brain emerged: the neuroanatomical brain, which arose from the development of functional, neurological and neurosurgical localization, and the neurophysiological brain, which relied on the neuron doctrine and enabled pre-modern electrophysiology. While the neuroanatomical brain stems from studying brain function, the neurophysiological brain emphasizes brain functioning and aims at understanding mechanisms underlying neurological processes. Conclusion: In the 19th and 20th century, the brain became an organ with an intelligible and coherent physiology. However, the various discoveries were tributaries of two different conceptions of the brain, which continue to influence sciences to this day. Relevance: With modern cognitive neuroscience, functional neuroanatomy, cellular and molecular neurophysiology and neural networks, there are different analytical units for each type of neurological science. Such a divide is a vestige of the 19th and 20th century development of the neuroanatomical and neurophysiological brains. history of medicine, history of neurology, cortical localization, neurophysiology, neuroanatomy, 19th century 1Faculty of Medicine, McGill University, Montréal, Canada. 3Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada. Corresponding Author: Kamiar Mireskandari, email [email protected]. Issue 16 mjmmed.com Introduction Hippocratic doctors, on the other hand, emphasized rejection of the supernatural and emphasized clinical In this narrative review, I will explore the birth of 2,3,4 cortical localization and the anatomo-clinical method examination . The epitome of medicine and in the 19th century and the revolutionary neuron neuroscience in the Antiquity is Galen’s masterful doctrine in the early 20th century. These themes will be combination of careful anatomical experimentation and approached thematically rather than chronologically. clinical reasoning. In synthesizing Hippocratic and While other authors have elegantly placed Alexandrian medicine, Galen was able to explain why neurophysiology within the broader context of patients undergoing goiter surgery often suffered from experimental physiology, I will argue that in the span of aphonia; indeed, he famously successfully reproduced two hundred years, two different brains: the this finding by vivisecting a dog’s recurrent laryngeal 5,6 neuroanatomical brain, exemplified by cortical nerve. This newly found interest in neuroanatomy did localization and the anatomo-clinical approach, and not translate into any change in explanations of the neurophysiological brain, exemplified by the physiology; Galen still attributed the function of the 7 neuron doctrine and electrophysiology. I will brain to a vital spirit and Hippocrates’s four humors distinguish between brain function, understood as the doctrine would go on to be the dominant theory of attribution of physiological functions to discrete disease until the Renaissance. For the several centuries anatomical structures, and brain functioning, following Galen, knowledge of brain structure changed understood as an approach to nervous system very little and debates revolved around metaphysical functioning and physiology that emphasizes questions. Despite Vesalius’s publication of Fabrica in mechanisms. I will argue that the current state of 1543, which included a new level of neuroanatomical th neuroscience, with the various different levels of detail, the 16 century did not challenge classical understanding, represents the heritage of this very Galenic physiology. For both Greek and Renaissance particular historical development. thinkers, brain function and brain functioning were regarded as theoretical questions that were best solved Discussion through reasoning rather than experimentation. If they did not willfully emulate Greek and Renaissance The brain as a physical entity: localization of scientists, proponents of cortical localization and the function and the anatomo-clinical approach anatomo-clinical approach in the 18th and 19th centuries For a most of human history, the brain has been an certainly owe the description of countless element of fascination. As early as 1600 BC in Ancient neuroanatomical structures and the introduction of Egypt, the famous Edwin Smith Surgical Papyrus in many anatomical terms to the work of these great Ancient Egypt described several brain lesions and anatomists. This section will explore the birth of cortical reported on spinal cord injuries. However, it is in localization, the anatomo-clinical approach and Greece, in the 5th century BC, that a first true model of functional neurosurgery. the brain arises. It is in 1664 that Thomas Willis published his seminal Aristotle (384-322 BC) was the most influential paper Cerebri anatome. In many ways, this work Greek physician and argued strongly for the use of marked a transition between the philosophical animal dissection to unravel the mysteries of human approach to brain function and the emergence of nature. This emphasis on the empiric study of the functional anatomy. Influenced by William Harvey’s human body along with some very specific political discovery of circulation, Willis based his theories on conditions led to ted to the widespread use of human comparative anatomy and clinical cases rather than a dissection in Alexandria in the 3rd century. Indeed, priori theories about the mind. Thus, it was his Herophilus and Erasistratus, two famous Alexandrian observation that lesions to the cerebral hemispheres anatomists, provided the first descriptions of the affected the ability of patients to recall8 that guided his 1 cerebrum, the cerebellum and the cranial nerves . theory of memory being assigned to the cerebral gyri.9 1 Aristotle’s emphasis on the empiric study of the human body along with some very 4 ibid., 131. specific political conditions led to the widespread use of human dissection in 5 A. Karenberg, "Chapter 5: The Greco-Roman World," Handbook of clinical neurology Alexandria in the 3rd century. Please see Lloyd G. Alcmaeon and the Early History of 95 (2010). Dissection." Sudharch Sudhoffs Archiv 59, no. 2, 1975, 113-47 p.p. for a detailed 6 Stanley Finger, Minds Behind the Brain : A History of the Pioneers and Their Discoveries review of the early history of dissection. (Oxford ; New York: Oxford University Press, 2000), 43-44. 2 Hippocrates et al., Hippocrates (Cambridge, Mass.; London: Harvard University Press 7 Origins of Neuroscience : A History of Explorations into Brain Function (New York: Oxford ; W. Heinemann, 1923), 139-79. University Press, 1994). 3 As Geoffrey Lloyd, "Alcmaeon and the Early History of Dissection," sudharch 8 Finger S. Minds behind the brain : a history of the pioneers and their discoveries. Sudhoffs Archiv 59, no. 2 (1975). demonstrates, it is quite clear that their physiological Oxford ; New York: Oxford University Press; 2000. xii, 364 p. p. constructs were never empirically verified and that dissection played little if any role in 9 Finger S. Origins of neuroscience : a history of explorations into brain function. their vision of the brain. New York: Oxford University Press; 1994. xvii, 462 p. p. Issue 16 mjmmed.com Likewise, his classical description of the brain’s arterial had lost the ability to speak when he noticed a “chronic supply and of the eponymous Circle of Willis was and progressive softening, which was centered in the based on careful experimentation10 and skillful third frontal convolution of the left hemisphere.”23 He dissection.11 As a clinician, Willis gave the first presented his findings to the Société d’Anthropologie description of myasthenia gravis12 and narcolepsy13, in in 1861. This single case is perhaps the most important addition to coining the words neurology and in the history of neurology; it convinced most psychology. In trying to correlate structure, function neuroscientists that function can indeed be ascribed to and clinical deficits, one can argue that Willis planted specific cortical areas.24 John Hughlings Jackson, the the seed for what would become the anatomo-clinical father of British neurology, was one of those.25 Indeed, approach. the physiologist expanded on Broca’s discoveries, noting that the right hemisphere appeared to mediate If neuroanatomy and clinical neurology continued to spatial perception26 after seeing a man incapable of evolve throughout the end of the 17th and the beginning recognizing both his surroundings and his family.27 of the 18th century, Franz Joseph Gall and Paul Broca’s Later, Jackson would observe that seizures often paradigm-changing theory of cortical localization the “march” from one limb to another, a finding which advent of functional neuroanatomy. In 1792, Franz could only be explained by the motor cortex having Joseph Gall, having examined hundreds of skulls from different regions corresponding to various body parts.28 individuals with over- or underdeveloped faculties,14 (6) This new concept of cortical