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Neurosurgical Classic--XII Neurosurgical Classic--XII ROBERT H. WILKINS, M.D. Division of Neurosurgery, Duke University Medical Center, Durham, North Carolina hE initiation of modern neurological of cerebral localization and phrenology was surgery was made possible by three Pierre Flourens, whose studies on animals T discoveries in the nineteenth century. indicated to him that cerebral gray matter The introduction of two of these, anesthesia was homogeneous and equipotentia]. Flour- and antisepsis, vastly increased the scope of ens was an established physiologist, and his surgery in general, and made brain surgery authoritative views were accepted for half a feasible technically. Such operations were century.~3,J6,~7 performed rarely, however, because there Itowever, clinical evidence to the contrary was no way to locate lesions that did not was accumulated. For example, Jean Bouil- involve the skull. The problem was solved laud and Paul Broca found that injuries to when it was discovered that in the brain the third left frontal convolution resulted in there is focal representation of bodily func- motor aphasia, and Hughlings Jackson de- tion. This third fundamental concept-- fined the relationship between convulsions on cerebral localization--became an important one side of the body and disease of the oppo- part of the foundation on which modern site hemisphere2 ,9,n,J3,17 Related experimen- neurosurgery was built. 14 tal studies did not support these clinical Since the dawn of recorded surgery it has observations immediately, probably because been recognized that brain injuries are some- of the crude laboratory apparatus then in times accompanied by localized losses of use. In the early nineteenth century Luigi bodily function. In the fifth century B. C., Rolando had observed muscular contractions Hippocrates noticed the association between during the electrical stimulation of the cere- brain damage and aphasia, ophthalmoplegia, bral hemispheres of a pig. 17 But it was not and anisocoria2 ~ He also recognized that until 1870 that the doctrine of cerebral local- unilateral brain injury occasionally is fol- ization was placed on a firm basis by experi- lowed by convulsions or paralysis of the mentation. opposite side of the body2 However, for In that year, two young Berlin physicians, twenty-three centuries there were no scien- Gustav Fritsch and Eduard Hitzig, pub- tific theories advanced to explain these asso- lished the results of cerebral stimulation and ciations. Instead, interest in cerebral physi- ablation in dogs. 2 Because there had been no ology centered around philosophical discus- suitable laboratories available to them, they sions of the seat of the soul2 ,~2,17 did their first experiments in Hitzig's home, In the early nineteenth century Franz operating on Frau Hitzig's dressing table) Joseph Gall and Johann Caspar Spurzheim Despite these modest facilities, Fritsch and advanced a pseudoscientific theory of brain Hitzig produced a classical work which op- localization known as phrenology.7,9,~5,~7 posed the prevailing concepts of cerebral These men believed that various subdivisions function. Their experiments were confirmed of the brain governed various intellectual by David Ferrier, and initiated a series of activities, and that the relative development similar studies which made possible the first of the subdivisions could be assessed by modern operations for localized cerebral examination of the overlying cranium. Al- lesions. 17 though certain aspects of their theory were Fritsch produced no scientific contribu- correct, most of their ideas were so absurd tions of note after 1870, but Hitzig continued that the entire theory was rejected by most to contribute to the understanding of cere- scientists. Especially opposed to the concepts bral localization for 35 years. 4-6,s 904 Neurosurgical Classic--XII 905 References central part of the nervous system other ideas 1. BALLANCE, C. A glimpse into the history of the exist, though to be sure certain aspects of these surgery of the brain. Lancet, 1933, 1: 111-116; 165- are not accepted generally. It would be too long 17~ (see p. 114). a process and it would also not serve the special 2. FmTSCn, G., and HiTzm, E. Ueber die elektrisehe purpose of the present work if we wanted to men- Erregbarkeit des Grosshirns. Arch. Anat. Phy*iol. tion from the enormous relevant literature only wiss. Med., 1870, 37: 300-333. the results that seem to us reliable and that were 8. HnAD, H. Aphasia: an historical review. Brain, obtained by stimulative experiments on all the 1931, 43: 390-411. separate parts of the central nervous system. 4. HiTzio, E. Untersuchungen tiber das Gehirn. Ab- However, while with regard to the excitability of handlungen physiologischen nnd pathologischen Inhalts. Berlin: A. Hirschwald, 1874, xiii, ~76 pp. the organs composing the brain stem there exists 5. HITzm, E. Hughlings Jackson und die motori- a very great difference of opinion regarding schen Rindencentren im Lichte physiologischer stimulations other than organic ones, while very Forschung. Berlin: A. Hirschwald, 1901, 39 pp. recently a violent dispute broke out about the 6. HITZIG, E. Welt und Gehirn. Berlin: A. Itirsch- excitability of the spinal cord, the conviction wald, 1905, viii, 67 pp. generally has been held since the beginning of the 7. HOLLANDER,B. The centenary of Francis Joseph century that the hemispheres of the cerebrum are Gall, 1758-1838. Med. Life, 1938, 35: 373-380. absolutely not excitable by any stimuli familiar to 8. KUNTZ, A. Eduard Hitzig (1838-1907). In: The physiologists. founders of neurology. W. Haymaker, Ed. Spring- field, Ill.: Charles C Thomas, 1953, xxvii, 479 pp. Hailer and Zinn ~ alleged that they saw convul- (see pp. 138-143). sive movements when the medullary substance of 9. LEVINSON, A. Early studies of cerebral function. the cerebrum was injured. However, at that time Bull. Soc. med. Hist., Chicago, 1923, 3: 116-131. people were too little accustomed to a strict limi- 10. METTLER, C. C. History of medicine. A correla- tation of the stimuli used, which meet almost in- tive text, arranged according to subjects. F. A. surmountable obstacles in the brain, to pay much Mettler, Ed. Philadelphia: Blakiston Co., 1947, attention to these data later. As Longer remarked, xxix, 1315 pp. (see p. 490). it is probable that those experimenters had pene- 11. RIESE, W. The early history of aphasia. Bull. Hist. trated up to the medulla oblongata with their Med., 1947, 21 : 8~3-834. 13. RIESE, W., and HOFF, E.C. A history of the doc- instruments. trine of cerebral localization. Sources, anticipations, But Longet 2 himself says the following on the and basic reasoning. J. Hist. Med., 1950, 5: 50-71. subject: 13. RIESE, W., and HOFF, E.C. A history of the doc- "On dogs, rabbits, and on some kids, we have trine of cerebral localization. Second part: Methods stimulated the white substance of the cerebral and main results. J. Hist. Med., 1951, 6: 439-470. lobes with the scalpel; we have cauterized it with 14. SCARFF, J.E. Fifty years of neurosurgery, 1905- potassium, nitric acid, etc., we have passed gal- 1955. Int. Abstr. Su'rg., 1955, 101:417-513 (see p. vanic currents in every direction through it, 418). without succeeding in initiating involuntary 15. TEMKIN,O. Gall and the phrenological movement. Bull. Hist. Med., 1947, 21 : s muscular contractions or developing convulsive 16. TIZARD, B. Theories of brain localization from twitchings; the same negative result was ob- Flourens to Lashley. Med. Hist., 1959, 3: 183-145. tained by directing the same agents toward the 17. WALKEn, A.E. The development of the concept of gray or cortical substance." cerebral localization in the nineteenth century. Bull. Magendie's vivisectionsa led to the same results. Hist. Med., 1957, 31 : 99-1~1. Later we shall deal with the rather similar con- clusions of Flourens which are based upon results The Electrical Excitability of the Cerebrum* of bisections and denudations. Matteucci 4 also found the cerebrum and cere- G. FRITSCH AND E. HITZIG bellum of the rabbit to be entirely nonexcitable by electrical stimuli. Physiology ascribes to all nerves, as a necessary Van Deen,5 with whose name the theory of non- condition of the concept, the characteristic of ex- citability, i.e. the capability of responding with 1 M6moires sur la nature sensible et irritable du corps their specific energy to all the influences by which animal. Lausanne 1756, vol. I, p. 301, ft. their state is changed at a certain rate. But for the 2 Anatomic et physiologic du syst6me nerveux de l'homme et des animaux vert6br&. Paris 1843, vol. I, p. 644, ft. * Translation of: Ueber die elektrische Erregbarkeit 3 Lemons sur les fonctions et les maladies du syst~me des Grosshirns, by G. Fritsch and E. Hitzig, Archivf~r nerveux. Paris 1839, vol. I, p. 175, ft. Anatomic, Physiologic und wissensehaflliche Medizin, 4 Trait6 des phSnom~nes 61ectrophysiologiques des 1870, 37: 800-882. Printed with the kind permission of animaux. Paris 1843, p. 343. Spriuger-Verlag, Berlin, Gbttingen and Heidelberg, 5 Moleschott's Untersuchungen u.s.w, vol. VII, no. Germany. IV, p. 881. .
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