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A History of Neuropsychology


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as well. Luys [42] compared patients with opposite-side lesions, their locations in most cases indicated by the side of hemiplegia and confirmed by autopsy. Whereas “ordinary” right-hemiplegics (with left-side lesions) are “apathetic,” “silent,” and “stricken with hebetude,” “emotional” left-hemiplegics show “an abnormal impressionability … respond[ing to questions] in a limping voice, broken up by a kind of sobbing.” Other times, “they are boisterous and loquacious” (pp 379–380). Leborgne, whom Luys presumably would have called “ordinary,” partly fit the pattern: silent save for his monosyllabic “tan” but, when angry, able to utter a multisyllabic curse – Sacré nom de Dieu! (Broca [17], p 344). (This was the exception I noted earlier.) To explain symptoms like these, Luys proposed an emotion center in the right hemisphere to complement the intellectual center in the left.

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      Localization of Symptoms or Localization of Function?

      Along with his reports on imperception, Hughlings-Jackson [38] made another signal contribution. He identified what he saw as a common error in interpreting clinical data: speech loss following F3 damage on the left was widely taken to mean that speech was located there. The error lay in equating localization of symptoms with localization of function:

      Whilst I believe that the hinder part of the left third frontal convolution is the part most often damaged (when speech is lost), I do not localize speech in any such small part of the brain. To locate the damage which destroys speech and to locate speech are two different things ([30], p 81).

      Hughlings-Jackson instead saw speech, and language more generally, as a dynamic process involving the integrated functioning of the whole brain, such that the more complex the task, the more regions involved, each contributing in its own way. The question was not, where is language located, it was, what is each region’s contribution? His answer was that language is represented in both hemispheres at different functional levels: Emotional utterances (the lowest level) were the least lateralized, or most bilateral, which explained the preservation of “emotional speech,” such as oaths and other “automatic,” “involuntary” phrases in persons with aphasia, persons like Leborgne. Comprehension was more lateralized, and “propositional speech” (the highest level), together with the background of conceptual thought it requires, depended wholly on the left hemisphere.

      Explanations of Hemispheric Specialization

      How could cerebral specialization be explained? For Broca [20], the challenge was significant because, in declaring that we speak with the left hemisphere, he noted that, except for certain “secondary convolutions,” the hemispheres were “perfectly alike” (p 381). (Malgaigne [10], we recall, saw things differently.) How, then, could asymmetrical control for speech be reconciled with the “general truths [the law of symmetry] it seems to contradict” (pp 381–382)?

      What about the right hemisphere? For the temporal and occipital lobes, Gratiolet found earlier convolutional development on the right, the reverse of that for the frontal lobes. For the occipital lobe, Broca reported the same for number: “the right is richer in convolutions” (in [53] but, with his focus on speech, would have had no reason to see it as significant. Hughlings-Jackson [38] had very good reason: “These anatomical facts, I submit, support the view … that the hinder part of the brain on the right side, is the chief seat … in the recognition of objects, places, persons, &c.” (p 70).

      The Role of the Corpus Callosum

      By the 1920s, with the discovery and further documentation of lateral differences in