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APHASIA DEBATE
ONE OF NEUROLOGY'S EARLIEST PERSONAL FEUDS

Every so often the practicing neurologist is tempted to say unkind things about a fellow physician. Such episodes are rare, thank goodness, but a particularly unnecessary consultation will sometimes evoke a brief paroxysm of misanthropy. Accidental historians remember that, in times past, passionate personal feuds could roil a neurological community for years. Just such a dispute set Parisian tongues wagging at the beginning of the twentieth century.

Pierre Marie was Charcot's pupil and his favorite, who hoped to succeed the great man at the Hospice de Salpêtriére. As a luminary of the Charcot school, Marie aroused the jealousy of Parisian professors who resented Charcot's domineering behavior.

In those days, academic advancement was a bruising business, every success being made at the expense of another's failure. Charcot had been a master of this uncompromising system, advancing his own candidates and denying others.

Charcot's friend and collaborator Alfred Vulpian was a senior physician at the Bicêtre, a somewhat less prestigious hospital. In 1892 his student, Jules Dejerine, published the exaggerated claim to have localized the pathology of tabes dorsalis, and he also wrote that Marie agreed with him. Within two weeks, Marie published a blistering response, not only attacking Dejerine's scientific ideas but also criticizing him personally. Although intensely personal disputes surrounded scientific claims for priority of discovery, then as now, Marie's attack was notably more severe than most. It was only the beginning.

AFTER CHARCOT'S DEATH: POLITICAL IN-FIGHTING

When Charcot died in 1893, his personal choice to succeed him was passed over in favor of Vulpian's candidate, forcing Marie to a post at the Bicêtre. At the same time, Marie was becoming dissatisfied with prevailing concepts of cerebral localization, notably the localization of aphasia. In 1897, he criticized the diagrams that were used to show the distribution of language centers in the dominant hemisphere. He also denied the somatotopic representation of the body in the internal capsule.

In 1906, Marie published a paper with the provocative title, “The third left frontal convolution plays no special role in the function of language.” In it, he asserted that language contains both sensorimotor and psychological elements and that it is a faculty rather than a sensorimotor function. He supported this with a series of pathological studies in which patients with lesions in Broca's area lacked any aphasia. He claimed that the faculty view of neurological function meant that patients with aphasia invariably have mental symptoms as well as physical ones. His article touched off a spectacular public row with Dejerine, who dismissed Marie's claims out of hand. In an exchange of articles, each man criticized the other's ideas and character.

THE PARIS APHASIA DEBATE

Marie and Dejerine faced each other in a three-part debate at the Société de Neurologie de Paris in 1908, a gathering now called the Paris aphasia debate. Tinged with personal animosity between the two men, the debate proved inconclusive in settling the issue of the nature of language and the localization of lesions in aphasic patients. The two men went their separate ways; when Dejerine died in 1917, his chair went to his bitter rival. Henry Head, commenting on the debate in 1926, noted that the participants often qualified their physiological observations with anatomical data. (See his Aphasia and Kindred Disorder of Speech Cambridge University Press 1926, pp. 71–76.) He reported that since the participants could not agree on the clinical features of various forms of aphasia, they could therefore not agree on anatomical localization.

Neither Pierre Marie nor Jules Dejerine managed an enduring victory in their personal war, though dispassionate observers found the affair faintly amusing. Possessed of strong egos and easily offended, the two professors used a scientific question to advance their personal disagreement. Such behavior is probably not unique in the annals of neurology, though the Paris aphasia debate was more public than usual. Accidental historians may want to remember the two Parisian professors the next time a personal dispute arises in the daily practice of neurology.

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Dr. George York, III, former Chair of the AAN History Section, has written extensively on the history of medicine. He is Chief of Neurology at Kaiser Permanente-Stockton in California.