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Aphasiology: Historical Overview

Aphasiology: Historical Overview. William F. Katz, Ph.D. COMD 7302. Early History. Egypt Hebrews Greece Rome. Edwin Smith surgical papyrus. 1600-2500 BCE 5 meters long 50 + cases, ordered head  foot (but stopped at the thorax)

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Aphasiology: Historical Overview

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  1. Aphasiology: Historical Overview • William F. Katz, Ph.D. COMD 7302

  2. Early History • Egypt • Hebrews • Greece • Rome

  3. Edwin Smith surgical papyrus • 1600-2500 BCE • 5 meters long • 50 + cases, ordered head  foot (but stopped at the thorax) • Language and speech not linked to thought, not considered essential to humanity • In describing temporal lobe wound: “something entered from the outside… the patient was silent in sadness”

  4. Hebrew writings • Loss of speech does not imply loss of soul • Soul located in heart • Unity of the soul: Mental faculties are not fractional

  5. Greeks - Homer • Legendary blind poet – perhaps fictional (?) • Probably lived in 9th – 11th C BCE • Author of Iliad and Odyssey – recorded ~700 BCE • Two types of speechlessness: • Aphasia – loss of speech due to emotion • Anaudos – loss of the human faculty of language

  6. Sophocles: • 496-406 BCE • Famous Athenian playwrite (Electra; Oedipus Rex) • Introduced the term: Aphonos - Loss of speech/voice

  7. Greeks – Hippocrates • ~ 400 BCE • Father of modern medicine • Noted individual differences in severity of disease symptoms • Thoughts, ideas, and feelings come from the brain and not the heart • “an incised wound in the temple produces a spasm in the opposite sides of the body” • “Speechlessness follows convulsions with paralysis of tongue”

  8. Hippocrates • Aphonos attributed to “excessive repletions of blood vessels” (i.e., stroke) • Head injury as source of speech loss • Correlation between paralysis and speech loss

  9. Plato • Nickname, literally “broad” (shoulders) • 427-327 BCE • Founded the first Academy (from a Cademus – the land of cademus) • Philosopher, mathematician

  10. Plato • Thought = “Inner speech”

  11. Aristotle (384-322 BCE) • Philosopher, logician, politician • Distinguished voice, articulation, and speech • Proposed organs unique to each • Speech = product of reason • Reason comes from the senses

  12. Aristotle • Political origins of language

  13. Romans • 30 CE • Valerius Maximus • 1rst case of traumatic alexia • Early localization of brain functions assigned to ventricles

  14. Galen (CE 131 – 200) • “Head centered” view of aphasia • Origins of ventricular theory of brain activity • Language as unique to and defining of humanity (from Stoic philosophy)

  15. From Rome to the middle ages • Justinian code (539 CE): • Speech as a requisite for Roman citizenship • Christian middle ages: • Speech is a property of the soul • Not a topic of scientific inquiry

  16. Byzantine and Arab tradition • Neuroanatomy: Sites of function • Ventricles, Meninges • Neurophysiology (Greek Tradition) • The four humors: • Blood • Phlegm • Yellow bile (“choler”) • Black bile (“melancholy”)

  17. Medieval Renaissance • Return of medical science • Clinical observation and translation • Emergence of Universities • Dissections permitted at Bologna (1326) • Role of the great plagues

  18. Andreas Vesalius (1500s) • First insights into activity of the nervous system. • “Nerves serve the same purpose to the brain that the great artery does to the heart, and the vena cava to the liver, in as much as they convey to the instruments to which it ought to be sent the spirit prepared by the brain, and hence may be regarded as the busy attendants and messages of the brain” • End of the ventricle theory

  19. Sample work of Vesalius

  20. Modern history of aphasia • Post-enlightenment • Strong European contributions

  21. Localizationists vs. holists

  22. Localization vs. Holism - Overview

  23. Franz Joseph Gall • 1758-1828 • Highly-respected neuroanatomist

  24. Gall • Psychological functions are separate and located in the cortex in separate places • Functions or faculties are innate • Bigger size – more developed function • Emphasis on empirical study, unity of function and • Structure (function is primary) • Size of brain regions in SPECIAL cases can be figured out from bumps on the skull • His student, Johann Spurzheim, promulgated the notion of “phrenology”. This discredited notion was connected with Gall for many years.

  25. Gall – main insights • Contralateral organization of neural control over bodily functions • Distinction between grey and white matter • Origins of cerebral convolutions in the growth and folding of the developing brain • Nerves do not all descend from a single brain

  26. Jean-Baptiste Bouillaud • 1796-1881 • Kept Gall's ideas alive during the long winter of its official disrepute. • Known for a description of loss of speech in the absence of paralysis of the tongue • Bouillaud's Wager

  27. Bouillaud • 1825 treatise sparked a revival of interest in Gall and language localization

  28. Ernest Aubertin • Son-in-law of Bouillaud • 1861 mentioned a patient with traumatic frontal cranial deficit. When he applied light pressure while the patient was speaking he would stop in midword. • Worked with Broca at Bicetre • Contributed to Broca’s famous case of Leborgne • Specified the connection between anterior brain damage and loss of speech

  29. Pierre Paul Broca • 1824-1880 • French pathologist, anthropologist, neurosurgeon • Also a craniometrist • From relatively progressive Huguenot background • Founded the Anthropological Society to join Darwin in opposing the immutability of races • Dissociates from phrenology, but works on Bouillaud’s wager • Published over 500 scientific papers

  30. Broca • Localizes faculty of articulate speech in third frontal convolution “aphemia” • Makes key contributions on laterality “we speak with the left hemisphere” • Important links between laterality and handedness

  31. Broca's Drawing

  32. M. Leborgne's Brain“Tan tan”

  33. Lelong’s brain – details

  34. Marc Dax • 1771-1841 • Correlated loss of speech with right hemiplegia, due in some cases to known LH trauma • Some argue he should have received the credit for Broca’s localizationist claims because he made the discovery 25 years earlier

  35. Karl Wernicke • 1848-1905 • Prussian-born German neurologist and psychiatrist • Published Der aphasische Symptomenkomplex at age 26

  36. Wernicke • Introduced important concept of reflex arc and physiological vocabulary • Careful description of functional disturbances as well as pathological detail • Model has predictive value • Birth of information processing models

  37. Wernicke's Arc, 1874

  38. Ludwig Lichtheim • 1845-1928 • German physician • Über Aphasie. Deutsches Archiv für klinische Medicin, Leipzig, 1885 • Important modeling work (see next slide)

  39. Lichtheim's Model Accounts for • Transcortical motor aphasia • Deep dysphasia

  40. Adolf Kussmaul • 1822-1902 • German internist • Expert in psychology, psychological chemistry, pathology, and neurology • Identified “agrammatism”, inspired linguistic models (see next slide)

  41. Kussmaul's Model  Accounts for: 1. Isolated anomia 2. Isolated comprehension 3. Knowledge of phonologic information without being able to speak

  42. Wernicke/Lichtheim model

  43. Localizationists vs. holists

  44. Rene Descartes • 1586-1650 • Perhaps the most important philosopher and scientist in Western history • Many linguists and cognitive scientists consider themselves “Cartesians”

  45. Cogito Ergo Sum • The only certainty Descartes feltwas that he could doubt • But, through doubting:Doubting was thinkingThinking required a thinkerTherefore he did, in fact, exist • Hence:  I think, therefore I am

  46. Innate Ideas • Innate ideas were natural components of the mind • Some ideas were so clear and distinctive they had to betrue, even without personal experience • Descartes had ideas that were perfect, even if he wasn’t • Descartes could not have had these ideas on his own • Therefore GOD put those ideas into a person’s head • Some Innate Ideas: Unity/Infinity/Perfection

  47. Descartes’ Contributions • Mechanistic views on behavior • These views influenced:- Behaviorism- Stimulus – Response Psychology- Comparative Psychology- Physiological Psychology • Re-focused Conflict- Animal vs. Human- Rational vs. Irrational • Notion of “Mind” Permitted study of consciousness

  48. Descartes • His dualistic model of mind and body (“substance dualism”) denied the mind any materializability or localizability. • Therefore, his legacy tended to work against the localizationist concept.

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