Franz Josef Gall

"How did I achieve what I did? I never would make plans, I never knew what I would come to.
I have been guided by the purest, the most innocent instinct. I was not led by interest,
nor by honors, nor by money. The sole blind impulse to force the
secrets of nature, animals and men, did it." --F.J. Gall

Personal History

Franz Josef Gall was born in 1758 at Tiefenbronn (Baden), the son of an Italian merchant. In 1777 he began medical studies with Jean Hermann in Strasbourg, and there developed an affinity for research, particularly in comparative anatomy. He also acquired a wife, Miss Leisler (whose first name apparently was not recorded for posterity) as well as a variety of mistresses, one of whom bore him a son, Hamann. As a result, Gall's marriage was not pleasant; however, he did not let this dissuade him from his exploits, and was quoted as saying cheerfully, "Neither sin nor friends will ever leave me" (Ackerknecht & Vallois, 1956, p. 7).

Gall received his medical degree in Vienna in 1785 and established a general practice. His collaboration with his pupil Johann Christoph Spurzheim, which began in 1800, led to the development of his theories concerning brain localization and phrenology (initially referred to by Gall as cranioscopy). He characterized his primary goal -- to develop a functional anatomy and physiology of the brain as well as a revised psychology of personality -- as "organology." (As explained in more detail below, Gall ultimately identified 27 discrete brain "centers" of behavior, 25 of which have never been confirmed to exist. The two that he managed to hit on concerned language and word memory, and that's why you're reading this at all.)

In 1801, the Emperor Francis I put a halt to Gall's research efforts, citing moral and religious contradictions leading to charges of "materialism" and "fatalism." A number of prominent scientists and philosophers were developing a body of theory and clinical data demonstrating that "spirit," or "soul" -- viewed by the masses (a la Descartes) as the driving force of all activity, including cortical, via the pineal gland -- was perhaps fundamentally different from such functions after all, and that some inherent physical apparatus might well underlie behavior and cognition. The powerful Church political leadership found this viewpoint more than a little threatening. (So the separation of church and state was predated by the separation of church and pate?) Undaunted, Gall left Vienna with Spurzheim in 1805 and traveled throughout Europe spreading his new doctrine to mixed reviews. "Charlatanism" and "greed" were not uncommon accusations, though it has been acknowledged that Gall seemed less interested in material reward than in having his ideas accepted. He was also well received in certain circles, particularly among fellow scientists, and earned the public respect of the writer Goethe, credited by some with the first detailed description of aphasia in his Wilhelm Meister's apprenticeship, published in 1842 (see Appendix A to read this passage).

Gall arrived in Paris in 1807 and remained there until his death in 1828. Physician to dukes and embassies as well as prominent liberals such as Stendhal, he also taught his doctrines at the Athenee (much to the displeasure of anti-German, anti-materialist Napoleon, whom Gall had found to be a less-than-suitable phrenological subject due to the small circumference of his head). However, Gall was never elected to the Academie des Sciences, a great disappointment to him. In 1810, he published his main work "Anatomie et physiologie du systeme nerveux en general, et du cerveau en particulier, avec des observations sur la possibilite de reconnaitre plusieurs dispositions intellectuelles et morales de l'homme et des animaux, par la configuration de leur tetes," the first two volumes of which were written with Spurzheim. Spurzheim subsequently split from Gall and moved to England in 1813, where he continued to successfully develop the phrenological movement. After the death of Miss Leisler, Gall took a second wife, Marie Anne Barbe, in 1825. He suffered a fatal stroke in 1828, and Gall's own head was added to his collection of 300+ human skulls, skull casts, and brain casts.

A brief history of localization theory and aphasia

Observations and hypotheses regarding speech and language -- and the lack thereof -- extend back through the centuries. Physician observations of aphasic symptoms were recorded as early as 3500 B.C. in the Smith Surgical Papyrus. Documents such as the Hippocratic Corpus (400 B.C.) described numerous cases of loss of speech and distinguished between types of speech loss, such as between aphasia and anarthria, or between aphasia and loss of vocal ability. One case identifies temporary loss of speech subsequent to convulsions and paralysis of the tongue and right side of the body; another notes that wounds to one side of the head cause opposite-side muscular spasms. Though loss of speech was generally associated with other problems such as epilepsy, chronic illness and apoplexy (i.e., stroke), it appears that speech impairments were often described in conjunction with brain injury.

In the 1st and 2nd centuries A.D., Greek and Roman physicians described speech impairments due to paralysis as well as other causes, possibly related to memory loss, though this is not well specified. The Romans are credited with the first reference to alexia, documented by Valerius Maximus (30 A.D.), which described a man hit in the head with a stone who subsequently lost his memory for letters but whose speech and language were otherwise intact.

Few observations concerning aphasia persist from the Dark and Middle Ages. Bruyn (1982) refers to a physician who, during the Middle Ages, described an apparent global aphasia in reference to damage of the third ventricle.

The Renaissance brought with it concerted efforts to assign function to different portions of the brain. Numerous versions of brain division abounded, dividing it into anywhere from three main sections to more complex, subdivided interpretations. Galenic neuropsychology posited a broad localization of function with perception residing anteriorally, reasoning in the middle portion, and memory in the posterior brain. Eventually, in some versions, the functions were reassigned to the corresponding ventricles. Antonio Guainerio, an early 15th-century Italian physician, described two patients in this context -- one who could say only three words, and the other with severe naming problems -- and attributed the problems to an "excessive accumulation of phlegm in the posterior ventricle" responsible for impairing memory function. Many Renaissance writers offered more complex observations of speech-related difficulties, such as paraphasias and alexia without agraphia.

In the 16th century, von Grafenberg was one of the first to attribute a possible lingual motor component to loss of speech. He also proposed a separate kind of "central, brain-related" type of speechlessness, recording observations of patients who could not speak, but who could move their tongues, and attributing their problems to loss of memory (see Appendix B for a famous passage from his work). The 16th century also produced a number of documented surgical cases of patients who were "cured" of their aphasias after removal of bone fragments from their skulls.

Numerous contributions to the study of aphasia continued throughout the 17th and 18th centuries. Johann Schmidt (1673) produced a paper describing an acquired alexia with preserved writing; in the same paper, he appears to distinguish, probably for the first time, a paraphasia as distinct from a simple motor aphasia (e.g., apraxia). Rommel (1683) described in detail a patient who could produce serial speech while at the same time demonstrating severe auditory comprehension difficulties. In 1770, Johann A. P. Gesner published many descriptions of aphasia, including a case of jargon aphasia with jargon agraphia. Gesner took a giant step for localization theory (in the context of associationism) by attributing aphasia to a specific impairment of verbal memory. He proposed that it stemmed from "brain disease" causing a "weakness or inertia between different parts of that organ," and subsequently an "inaccurate association between thought and verbal symbol ... so that paraphasic or neologistic speech is uttered ... thus paraphasia and jargon aphasia reflect a forgetting of speech rather than impairment in thinking or understanding" (Benton, 1964, p. 320). Alexander Crichton (1798) and Van Goens (1789) both wrote on lack of awareness of deficit in cases of paraphasia and jargon aphasia. Crichton also elaborating his views, as well as Gesner's theories, on aphasia as being the result of "a defect of that principle, by which ideas, and their proper expressions, are associated."

So, by the time Gall arrived on the scene, a host of clinical aphasia types had been identified and described, many in direct relation to brain trauma. The groundwork had also been laid for exploring the connections, such as those between images and ideas, or images and linguistic expression, in the context of aphasic symptoms. It was up to Gall to incorporate the data collected up to that point into his main area of interest, and one as yet formally unexplored with respect to aphasia -- that of specific neuropathology. Was he up to the challenge? You bet!

For comprehensive overviews of the early history of aphasia, see bibliography citations for Benton, A.L., & Joynt, R.J. (1960) and Benton, A.L. (1964).

Size does matter: Gall's achievements and the emergence of phrenology

The development of Gall's doctrine concerning the modular aspects of brain function appears to date back to his teenage years -- inspired, it is suggested, by a friend of his who demonstrated sophisticated linguistic abilities as well as obvious frontal skull prominences. Gall's primary concern throughout his career was brain function; his theories stemmed from a potent mix of anatomical studies, pathological concepts, and his own brand of intuition. He proposed that "the skull is molded on the brain," and consequently proceeded to determine the configuration of brain structure, or "organs," from the bony attributes of the skull, which, at a malleable stage, would have developed over the prenatal/infant grey and white matter. Gall was especially interested in studying individuals who demonstrated extreme behaviors -- those who were especially gifted, or criminal, or insane -- and considered their particular skull prominences and depressions as representing those parts of the underlying brain that were over- or underdeveloped relative to their special characteristics. An unusually pronounced area indicated to Gall a particular talent, or overabundance, of traits relative to that assigned area of the brain; a recession in the skull demonstrated the lack of such attributes. Skull palpation, in this context, would demonstrate the strengths and weaknesses of an individual's personality traits and gifts. Gall preferred the term "cranioscopy" to describe such an analysis; Spurzheim and others were primarily responsible for the more popular use of the word "phrenology" to denote this approach. Gall amassed a large collection of skull and brain casts, including those of well-known writers, philosophers and artists, to serve as a basis for correlation and corroboration of his theories.

It should be noted that Gall, as devoted to function as he was, proved to be a skilled anatomist, and has to his credit some rather fundamental and important conclusions concerning brain and neural structure. Predating the emergence of evolution theory by some decades, he proposed that "by successive addition of new organs, nature progresses step by step and finally reaches up to man only through superposed cerebral productions" (Ackerknecht & Vallois, 1956, p. 14). Gall likened the nervous system to a tree, and saw the brain -- and the frontal lobes in particular -- as the final component in the central nervous system (CNS). He is credited with being the first to clearly separate and identify grey (neural components) and white (conductive) brain matter functions. He also documented that CNS fibers terminate in the cerebral cortex and not in the medulla as previously thought, noting a differentiation between medullar and cortical anatomy and stating clearly for the first time the importance of the cortex as a distinctive entity. Gall correctly identified the origins of cranial nerves I through VIII, and was the first to notice the presence of two discrete kinds of nerve fibers, "rentrants" or "divergents" (projection fibers) and "convergentes" (association/commissural fibers). He also appears to have proven, before anyone else, that the fibers of the pyramidal tracts cross the brain hemispheres, and so documented the basis for contralateral paralysis. As a proponent of the brain being composed of individual but connected systems, Gall formulated the basis for both modular and connectionist theories concerning brain function. His primary contributions concern the localization of function; localization of symptom, or lesion, was still to follow.

"Gall ... was the author of ... scientific revolution ... He had the undisputable merit
of proclaiming the great principle of cerebral localization, which -- it may be said --
was the starting point of the discoveries of our century concerning
the physiology of the encephalon."
                                         --Paul Broca, Academie Royale de Medicine, 1861

Gall drew on the work of his contemporaries, such as Locke, Condillac and Bouillaud (who took Gall's work a step further to propose a functional theory of interaction between the various organs of the brain, and who also delineated the difference between inability to speak due to memory problems and due to motor disturbances) to develop his body of work. As early as 1798, in a letter to Retzer, Gall outlined the four primary theses on which his explorations were based. They were found again, essentially unrevised, in his last book Sur les Fonctions, published in 1822:

These theories radically broke from the prevailing rationalist/sensualist philosophical ethos of the time by suggesting an anatomic/functional, rather than psychic or environmental, basis for speech (e.g., a theory that proposed words are not dependent on, or necessarily the result of, ideas). "Innate" qualities, according to Gall, were delivered by God, not by experience or intention. Calling his science "organology," he suggested that the brain was divided into 27 separate "organs," each corresponding to a discrete human faculty, though he identified 19 of these domains as being shared with other animal species. (See Appendix C for a list of the 27 brain organs named by Gall.)

As rigorous as Gall was in his dissection and analysis of the brain under autopsy, his methods for determing brain organ loci often veered toward the specious and absurd. For example, he was noted to identify the organ of reproduction by "feeling the hot nape of a hysterical widow." "Common sense" was another vehicle he described as using to arrive at his conclusions. Gall 's analyses in this context appeared to be based on some formal aspects of comparative anatomy, physiology, and trauma effects, obtained through observation and dissection, combined with a potent dash of age-old divination techniques that use body configuration to determine personal traits and characteristics. (Perspective, however, may perhaps be lent in noting that some of those who opposed him -- including prominent physiologists and psychiatrists of the time, such as Cabanis and Broussais, did so because they preferred to attribute certain traits and passions to the thorax and abdomen rather than the brain.)

Paul Eling, in the introduction to the chapter on Gall on his Reader in the History of Aphasia, states that "In a sense, the relation between phrenology and serious brain research has been considered similar to that between alchemy and chemistry or between astrology and astrophysics ..." (Eling, 1994, p. 5). However, Eling acknowledges Gall's contributions as "reasonable, revolutionary, and outstandingly progressive," based though they were on "dubious theory," and points out that Gall's work laid a solid foundation for the explorations of researchers such as Brouillard and Broca. He expands on the essential components of Gall's doctrine as outlined above; the following points flesh out the theory more completely:

It may be of interest to comment that Gall did not confine his radical notions to the field of neural anatomy and physiology. A naturalist who stated that "it is much more difficult to be virtuous than to be devout," he might perhaps be characterized as "libertarian" by today's standards, and certainly was seen as a radical social reformer during his lifetime. The concept of tolerance was central to his personal philosophy: "Everyone has the right of his own self, and an illimited tolerance for whatever does not upset the order of society . . . is the first duty, the most sacred, the most philosophical." He saw education as vital for all citizens, and made no distinctions between individuals of different races, stating that "All men have the same brains, therefore the same faculties and tendencies . . . a Negro and a European stand on the same level of the scale of the animal kingdom." Gall was particularly interested in initiating reforms concerning the treatment of prison inmates and mental patients. He promoted the notion that diseases of the mind were innate and quantifiable, rather than the result of moral lapse, and had a strong influence on the developing psychology of the time (e.g., the Esquirol school of "monomanias"). Gall also believed in reform, rather than punishment alone, of criminals, and proposed that personality characteristics be taken into account when sentencing: "The degrees of guilt and of expiation differ according to the conditions of the individuals." Although many of Gall's notions were left behind, his views and suggestions concerning social reform were carried -- and carried out -- well into the next century. (All quotes taken from Ackerknecht & Vallois, 1956, pp. 28-31.)

One lump or two: Gall's direct contributions to aphasia

"There exists a form of partial insanity limited to the faculty of speech ...
(a phenomenon) impossible if the faculty of spoken language
was not the function of a particular part of the brain."
                                    --F.J. Gall (1825); cited in Brown & Chodor, 1992, p. 479

As outlined above, Gall contributed significantly to the foundation for what eventually developed into an extensive theory of brain functioning based on modular principles. Although his partially-arcane methods and obtuse presentation alienated some of his peers, his work also attracted the attention of those who saw value in certain components of his theories, and who pursued further exploration, with greater commitment to empiricism, in these areas. Perhaps the best-known of these individuals is Paul Broca, who, with Bouillaud's son-in-law, published to great acclaim in 1861 an organic basis for aphasia in lesions located posterior and inferior to the frontal lobe, an area now known as "Broca's area" and which forms the neurological basis for "Broca's aphasia." Although Broca, as demonstrated in the above quote, was willing to acknowledge Gall's commitment to promoting localization theory, he was considerably less inclined to credit Gall with having identified virtually the same location in the brain 50 years earlier, to which Gall had assigned center #14, "memory for words," and its proximate, connected center #15, "the sense of language, of speech."

Gall's proposals for localization of word memory (e.g., word retrieval) and speech/language abilities had a stronger basis in his anatomical studies than did most of his other attributions of brain function. As a result of his clinical observations in this realm, Gall is, in fact, credited with the first complete description of expressive aphasia due to a wound of the brain. He also noted a relationship between speech problems and vascular lesions. He obtained the evidence for his theories concerning speech, language and word memory from observed points of wound entry, from dissections of brains which had endured trauma such as gunshots, stabbings, and (possibly) stroke, and from individuals diagnosed with retardation and dementia who presumably had frontal lobe damage. The case of Rampan (well-known in certain circles), who had endured penetration of a foil sword into his posterior left frontal lobe was described in detail by Gall, and included many signs and symptoms that we today associate with effects of stroke in that region, such as right hemiparesis and anomia. (Actually, Rampan may be perhaps one of the first documented cases of "dissociation" in the context of a language disorder -- he was classified as having difficulty remembering proper names, but no trouble recalling object labels.)

In the wake of Gall's research, numerous reports appeared documenting speech and language impairments in connection with damage to both left and right frontal lobes. The rest, as they say, is history (isn't it always?).

Appendices

Appendix A

". . . Although unexpectedly my father had a shock of palsy; it lamed his right side and deprived him of the proper use of speech! We had to guess at everything that he required; for he never could pronounce the word that he intended. There were times when this was dreadfully afflicting to us: he would require expressly to be left alone with me; with earnest gestures, he would signify that everyone should go away; and when we saw ourselves alone, he could not speak the word he meant. His impatience mounted to the highest pitch: his situation touched me to the inmost heart. This much seemed certain: he had something which he wished to tell me, which especially concerned my interest. What longing did I feel to know it! At other times, I could discover all things in his eyes: but now it was in vain. Even his eyes no longer spoke. Only this was clear: he wanted nothing, he desired nothing; he was striving to discover something to me; which unhappily I did not learn. His malady revisited him: he grew entirely inactive, incapable of motion, and a short time afterwards he died."

--Goethe, XX. (1842). Wilhelm Meister's apprenticeship. Cited in Riese, W. (1977). Selected papers on the history of aphasia. Amsterdam: Swets & Zeitlinger, p. 42. (It is speculated that Goethe modeled his description of aphasia on his maternal grandfather, who was left with speech problems and right-side paralysis secondary to a stroke in 1768.)

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Appendix B

"I have observed in many cases of apoplexy, lethargy and similar major diseases of the brain that, although the tongue was not paralyzed, the patient could not speak because the faculty of memory being abolished, the words were not produced."

--von Grafenberg, J.S. (1585). Observationes medicae de capite humano. Lugduni. Cited in Benton, A.L. (1964). Contributions to aphasia before Broca. Cortex, 1, p. 317.

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Appendix C

The first nineteen are organs common to men and animals; the final eight are specific to humans:

  1. The instinct of reproduction (located in the cerebellum).

  2. The love of one's offspring.

  3. Affection; friendship.

  4. The instinct of self-defense; courage; the tendency to get into fights.

  5. The carnivorous instinct; the tendency to murder.

  6. Guile; acuteness; cleverness.

  7. The feeling of propoerty; the instinct of stocking up on food (in animals); covetousness; the tendency to steal.

  8. Pride; arrogance; haughtiness; love of authority; loftiness.

  9. Vanity; ambition; love of glory (a quality "beneficent for the individual and for society").

  10. Circumspection; forethought.

  11. The memory of things; the memory of facts; educability; perfectibility.

  12. The sense of places; of space proportions.

  13. The memory of people; the sense of people.

  14. The memory of words.

  15. The sense of language; of speech.

  16. The sense of colors.

  17. The sense of sounds; the gift of music.

  18. The sense of connectness between numbers.

  19. The sense of mechanics, of construction; the talent for architecture.

  20. Comparative sagacity.

  21. The sense of metaphysics.

  22. The sense of satire; the sense of witticism.

  23. The poetical talent.

  24. Kindness; benevolence; gentleness; compassion; sensitivity; moral sense.

  25. The faculty to imitate; the mimick.

  26. The organ of religion.

  27. The firmness of purpose; constancy; perseverence; obstinacy.

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