Pierre Paul Broca

Born 1824
Died 1880

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French pathologist, neurosurgeon, and anthropologist, born June 28, 1824, Sainte-Foy-la-Grande, Gironde, Bordeaux; died July 9, 1880, Paris.

Biography of Pierre Paul Broca

Pierre Paul Broca made important contributions to anatomy, physiology and anthropology, and he was the founder of modern brain surgery.

He was the son of Benjamin Broca, a country practitioner and former Napoleonic surgeon with Huguenot background, known for "unflinching probity, courage and grave irony." His mother, known for "great intelligence" and a "prodigious memory", was the daughter of a protestant preacher. He received his basic education at the collège in his native town, where he earned the diploma as «Bachelier des lettres» at the age of only 16, and soon afterward became «Bachelier des Sciences mathemathiques".

At the age of seventeen, equipped with excellent certificates, he entered the University of Paris in October 1841, where he, at the request of his parents, attended the faculty of medicine. After two years he became externe in the department of the urologist and dermatologist Philippe Ricord (1800-1889) at the Hôpital du Midi. In 1843, following his victory at a concours for internship, he first worked under François Leuret (1797-1851) at the Bicêtre, later with Langier at the Hôpital Beaujon. Then, in 1844, his strong wish came through, and he became an interne with Pierre Nicolas Gerdy (1797-1856), anatomist, physiologist and surgeon. In 1846 he was appointed Gerdy’s assistant, and subsequently was permitted a fourth year of internship, with the surgeon Philippe-Frédéric Blandin (1798-1849) at the Hôtel-Dieu.

The great successes achieved by Paul Broca at the time he completed his studies, made his mother renounce her long-time wish of seeing her son as a practitioner of medicine in her home town, and allowed him to enter an academic career. In 1848 he became prosector of anatomy at the University of Paris Medical School, the youngest prosector and secretary of the Société Anatomique ever. There he described muscular dystrophy as a primary affection of muscle before Guillaume Benjamin Amand Duchenne de Boulogne (1806-1875). He also described rickets as a nutritional disease before Rudolf Virchow (1821-1902), and the venous spread of cancer independently of Karl von Rokitansky (1804-1878). The following year, in 1849, he was conferred doctor of medicine. Broca conducted the first experiments on the continent using hypnotism for surgical anaesthesia, and the introduction of the microscope into the diagnosis of cancer was partly due to his efforts.

In 1853 he won another concours with a superb thesis, becoming professor agrégé, and few days later was appointed Chirurgien des hôpitaux, an appointment causing much enthusiasm among «the young medical school» of Paris to which he belonged. This was partly based on the fact that Broca was one of the most eminent pupils of Hermann Lebert (1813-1878), a German who had become a naturalised Parisian.

In 1867 Broca was elected to the chair of pathologie externe at the Faculty of Medicine, and the following year he became professor of clinical surgery. In recognition of his outstanding scientific achievements, Broca in 1868 was elected member of the Académie de médecine and was called to the chair of surgery (pathologie externe) at the faculty, immediately changing this for the chair of clinical surgery, in which capacity he was active at the Hôpital St. Antoine, the Pitié, the Hôtel des Clinques, and at the time of his death, at the Hôpital Necker.

An interesting fact about Broca is that he also took an interest in public health and public education. He published several works in fields related to this, among them on infant mortality, on the population development in France, and on the medical service in the French army. He was concerned with health care for the poor, being an important figure in the Assistance Publique.

Later, as a member of the Senate, he advocated that the education of women should bed independent of the church, opposing bishop Félix-Antoine-Philibert Dupanloup’s (1802-1878) claim that the education of women should take place «sur les genoux de l’église.» Dupanloup, Roman Catholic bishop of Orléans, was a clerical spokesman for the liberal wing of French Catholicism during the mid-19th century.

Localisation of brain functions
Today, Paul Broca is mainly remembered for his epoch-making works on the localisation of brain functions. Based on observations of patients with brain damages, especially a case of motoric aphasia, Broca developed the concept of left hemisphere dominance for speech, and localised the speech centre to the posterior part of the third frontal convolution.

On the 4th of April, 1861, at a meeting of the Société d'Anthropologie, Broca sat in the audience as Ernest Aubertin presented a paper citing several striking case studies to argue the craniological case for cerebral localisation of articulate language. Aubertin was the student and son-in-law of Jean Baptiste Bouillaud (1796-1881 – Boulliaud's disease and Bouillaud's rule), himself a student of Franz Joseph Gall (1758-1828) and founding member of the Société Phrénologique. As early as 1825, Bouillaud had published a paper that employed clinical evidence to support Gall's view that the faculty of articulate language resides in the anterior lobes of the brain. For almost 40 years, in the face of considerable opposition, Bouillaud had succeeded in keeping the cerebral localization hypothesis alive. Thus, Aubertin was merely carrying on in his father-in-law's tradition when he promised to give up his belief in cerebral localization if even a single case of speech loss could be produced without a frontal lesion.

Intrigued, Broca decided to take up Aubertin's challenge. Within a week, a M. Leborgne, a speechless, hemiplegic patient aged 51 years died from gangrene on Broca's surgical ward at the Hôpital Bicêtre. 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 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. Tan's condition deteriorated gradually and on April 12, 1861, he was transferred to the care of hospital surgery for an immense, widespread gangrenous inflammation, 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.

Tan died on April 17, 1861 and his case was presented by Broca before the Société d'Anthropologie in Paris, with his father in the audience. Broca referred to the patients condition as aphémie, renamed aphasia by Armand Trousseau (1801-1867) in 1864.

With his publication of this case in 1861 Broca was the first to present anatomical proofs for the localisation of a particular brain function. In this article Remarques sur le siége de la faculté du langage articulé, suivies d'une observation d'aphemie (perte de la parole), Broca presented a detailed account of his post-mortem examination of Tan's brain, where he had found a superficial lesion in the left frontal lobe. From this and subsequent observations he concluded that the integrity of the posterior part of the left third frontal convolution was indispensable to articulate speech, and he therefore termed this region the circonvolution du langage. Later David Ferrier (1843-1928) referred to it as Broca's convolution.

On March 24, 1863, Broca's cautious view about the unheard of dominance for speech by the left cerebral hemisphere was received by the Académie de Médecine. On the same date and on the same page is recorded that Gustave Dax (1815-1893) deposited a hitherto unpublished memoir by his deceased father Marc, written in 1836. In a series of forty-odd patients Marc Dax (1771-1837) had correlated loss of speech with right hemiplegia, due in some cases to known left hemisphere trauma. Much heat was generated over these interpretations: first in the series of weekly meetings of the Académie de Médecine in 1865; three years later at the session of the British Association for the Advancement of Science in Norwich, where both Broca and Jackson expressed their latest; unfortunately their discussion, if any, is not on record (The Lancet, London, 1868, page 386). Posthumously Broca was again challenged by Pierre Marie, his former interne. In 1906 sought out the very brain described by Broca: it had a parieto-temporal lesion in addition to the frontal one insisted on by Broca.

In his work on brain localisations Broca collaborated with Louis-Pierre Gratiolet (1815-1865).

Later research has proved that Broca's centre is not quite in accordance with the real localisation of the speech centre, a fact that does not diminish his repute or the importance of his discovery.

Anthropology
In 1847 Broca served on a commission to report on excavations in the cemetery of the Celestins, and this led him to study craniology and ethnology. These subjects suited him well, for they allowed him to use his anatomical and mathematical skills as well as his diversified knowledge; and his synthetic abilities were necessary to coordinate the wide range of data presented. The word "anthropology" first appeared in the English language in 1593 (the first of the "ologies"). The word "ethnology" made its first appearance in an 1830 letter by André-Marie Ampère (1775-1836) and appeared in print for the first time in 1832. Broca had become acquainted with anthropology and ethnography through the works of Isidore Geoffroy-Saint Hilaire (1805-1861), Antoine Étienne Reynaud Augustin Serres (1786-1868) and Jean-Louis-Armand Quatrefages de Bréau (1810-1892).

Anthropology became a life-long interest with Broca. Already in 1858 he established the first anthropological laboratory, at the École des Hautes Études in Paris. At this time anthropology was considered by both church and government to be sinister and subversive, but Broca surmounted all opposition and eventually established it securely.

In 1848 he had founded a society of free-thinkers, and in 1858 and 1859, Broca, the heretic, denied the immutability of race and species – the offensive central idea also of Charles Darwin's (1809-1882) more famous work that year.

    "I would rather be a transformed ape than a degenerate son of Adam"
Broca was thus denounced by authorities as a subversive figure, a materialist and a corrupter of the youth. He felt compelled to establish a platform of his own: the world's first Anthropological Society, founded in 1859 followed by his School and Institute of Anthropology in 1876. He was the Society's Secrétair général from 1862. In 1872 he founded the Revue d'anthropologie. Getting permission to establish the society was difficult. The Ministry of Public Instruction and the Prefect of Police believed that anthropology must, as the free pursuit of knowledge about human beings, be innately subversive to the state. When permission was at last and reluctantly granted for Broca to talk about science with eighteen colleagues, the Prefect of Police held Broca responsible personally for all that might be said in such meetings "against society, religion, or the government. Even so, the study of human beings was considered so dangerous that a police spy in plain clothes was assigned to attend all meetings.
Not only the police but also the clergy opposed the development of anthropology in France, and in 1876 the Roman Catholic political party organised a major campaign against the teaching of the subject in the Anthropological Institute.

At the institute was lectured on comparative anatomy, ethnology, ethnography, demography, etc. Here was also taught craniometry and anthropometric measuring. During the last years of his life Broca spent some hours at this institute every day, concerning himself with craniometric studies, in which he took a particular interest, and for which he devised a number of ingenious instruments. Among the plethora of novel subjects he treated was Cro Magnon man an Neolithic trephination.

In his time, Broca was one of many scientists who believed they could measure man's intellectual qualities by the size of his brain. As this was disproved, scientists started using other measurable criteria, always resulting in a "proof" of the superiority of the white race in general and of northern Europeans in particular. To this may also be added a palpable sexism.

Broca invented at least twenty-seven instruments for more accurate study of craniology, and he helped to standardize methods. Between 1850 and his death he published 223 papers and monographs on general anthropology, ethnology, physical anthropology, and other aspects of the field.

Most of his works in the field of anthropometry were published in the Journal de physiologie and the Bulletins et mémoires de la Société d'anthropologie de Paris. He termed many craniometric points in the cranium, like bregma, dacryon, inion, lambda, metopion, obelion, and ophiston.

Broca – the man
Broca was strongly built, with an expansive forehead and lustrous brown eyes. Fiery, righteous, but benevolent, and an excellent raconteur, he was adored by his associates, described as generous and compassionate, and it is said that he never made an enemy and never lost a friend.

While still inn his thirties he furthered Charles-Édouard Brown-Séquard's (1817-1894) difficult career. During the Commune when, as vice-president of the Council of Public Assistance, Broca risked his life to spirit seventy-five million francs from that institution's treasury to the government in Versailles. To do this he devised the bold scheme of hiding the assets, stuffed into travelling bags, on an old wagon loaded with potatoes: the cart was safely driven past the Commune-manned gate of Paris. He received not so much as a vote of thanks from the conservative Government.

In recognition of his services he was elected in 1880 as a member for life of the Senate of the French republic, representing science, a recognition not only of his republican mind, but as much of his personal qualities. When his friends celebrated his election, he said with premonition:: «Je suis trop heureux! Tous les rèves d’ambition, qu’un homme qui a consacré sa vie à l’étude aurait pu faire, se sont réalisés pour moi et si j’étais aussi superstitieux que les anciens, je considérais ma nomination au Sénat comme le présage d’une grande catastrophe, peut-être comme un présage de mort.»

Unfortunately, his prophecy was soon to come true. On July 8 Broca, who had until then felt perfectly well, during a meeting of the senate was attacked pain in the shoulder. Back in his home he felt somewhat better, but in the evening had to rest on the sofa. Towards midnight he sensed the first feeling of being strangled (Erstickungsgefühl), and died few minutes later, aged fifty-six. The autopsy revealed no diseased condition of the heart or larger vessels, nor of the brain.

In his memorial speech, Ulysse Trélat said (1828-1890): Quarante années d’un travail sans trève, quarante années de dignité, de générosité, de patriotisme élevé, de dévouement `toutes les nobles causes voilà de Broca.»

Broca was married to the wealthy daughter of Dr. Jean Guillaume Auguste Lugol (1786-1851), of iodine fame. Both his sons distinguished themselves: Auguste Broca as professor of paediatric surgery, eponymously remembered for Broca-Perthes-Blankart operation for habitual dislocation of the shoulder joint, André Broca as professor of medical physics.

    «The least questioned assumptions are often the most questionable.»
    Quelques propositions sur les tumeurs dites cancéreuses.

    «If science must be the slave of either, a philosophical system opposed to religious dogma is just as objectionable as that dogma itself.»
    Bulletin de la Société Anthropologique, 1870; 5: 168.

    «Private practice and marriage - those twin extinguishers of science!»
    Letter, April 10, 1851.

    «Greedy for explanations, and rather than being satisfied with ignorance, the human mind treats itself to words devoid of meaning, like those American savages who in time of famine swallow clay to silence their empty stomachs.»
    Mémoirs de l’Académeie Nationale de Médecine, 1852; 16: 453.

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