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Atsushi Yamadori
Tohoku University Graduate School of Medicine
1-23 Iwazono-cho
Ashiya 659-0013 (Japan)
E-Mail dfckf900 @ kcc.zaq.ne.jp
Bogousslavsky J, Boller F, Iwata M (eds): A History of Neuropsychology.
Front Neurol Neurosci. Basel, Karger, 2019, vol 44, pp 39–52 (DOI: 10.1159/000494951)
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Alexia and Agraphia from 1861 to 1965
Victor W. Henderson
Departments of Health Research and Policy (Epidemiology) and of Neurology and Neurological Sciences, Stanford University, Stanford, California, USA
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Abstract
Studies of alexia and agraphia have played historically important roles in efforts to understand the relation between brain and behavior. In the second half of the 19th century, works by Paul Broca and Carl Wernicke led to the concept of delimited cortical centers in the left cerebral hemisphere concerned with discrete aspects of spoken and written language. These specialized centers were linked by white matter pathways. Charlton Bastian, Jean-Martin Charcot, Sigmund Exner, and Jules Dejerine championed center–pathway models of reading and writing. Dejerine played a dominant role, rejecting the idea of a left frontal lobe center that mediated writing and proposing a unique, specialized role for the left angular gyrus in both reading and writing. In 1891 and 1892, he detailed the symptoms of alexia and agraphia that resulted from injury to the left angular gyrus and from the isolation of the left angular gyrus from visual input required for reading. During the early 20th century, his work and that of other so-called diagram makers was confronted and largely discredited by Pierre Marie, joined later by Henry Head and Kurt Goldstein. In the 1960s, the center–pathway model was resurrected and refined by Norman Geschwind. He drew upon foundational works of Dejerine, Hugo Liepmann, and others to describe syndromes resulting from cortical disconnections and, in doing so, helped to establish a framework for the modern discipline of behavioral neurology.
© 2019 S. Karger AG, Basel
Introduction
Aphasia is an acquired disorder of language defined principally by deficits in speech and speech understanding. Reading and writing are the visual counterparts of spoken language. Disorders of reading and writing, viz., alexia and agraphia, are often considered in relation to the language impairments of aphasia. Studies of aphasia, alexia, and agraphia play a historically important role in understanding the relation between brain function and complex behaviors.
1861 is a useful starting point for the history of alexia and agraphia. This is the year in which the French surgeon and anatomist Paul Broca (1824–1880) described his first case of aphemia (Broca’s aphasia) [1]. A convenient place to conclude is 1965, when Boston neurologist Norman Geschwind (1926–1984) ushered in the modern era of brain-behavior studies with his publication on cerebral disconnection syndromes [2]. Aspects of this topic have been reviewed [3, 4].
Broca proposed an anatomical center within the cerebral cortex that mediated articulate language. This model, expanded by others to accommodate reading and writing, came to include several cortical centers with discrete functional roles, interconnected by subcortical white matter pathways. As in Broca’s original case, the role of a center was inferred from symptoms after tissue destruction within a delimited cortical area. The role of a pathway was often inferred from the function of centers that it connected. Early proponents of the center–pathway model included Wernicke, Bastian, Charcot, and particularly Dejerine, who provided a key theoretical framework for alexia with and without agraphia. Opposing views were espoused by Hughlings Jackson and later by Marie, Head, and Goldstein. Geschwind’s work represented a rediscovery and elaboration of earlier models in the mode of Broca and his successors.
Setting the Stage
Franz Gall (1758–1828), an accomplished neuroanatomist linked to the pseudoscience of phrenology, observed physical features of the head and related these to mental faculties. While still a student, he famously associated protruding eyes with an excellent memory for words. During the early 19th century, Gall described regional anatomical variations in the human brain, which he associated with mental abilities and behaviors observed during life [