Gert-Jan C. Lokhorst


G.J.C. Lokhorst. Review of P. J. Koehler, Het localisatieconcept in de neurologie van Brown-Séquard. Bulletin of the History of Medicine, 64: 316-318, 1990. ISSN 0007-5140.

Charles-Edouard Brown-Séquard (1817-1894) was one of the most prominent physiologists and neurologists of his time. Today, he is mainly remembered for the neurological syndrome which bears his name. He discovered this syndrome as a result of his work on the sensory pathways in the spinal cord. Contrary to the prevailing concept of his time, developed by Bell and Longet, Brown-Séquard showed that the sensory paths do not decussate at the level of the cerebellum. Unlike the motor fibres they cross to the contralateral side of the spinal cord within the cord itself. The Brown-Séquard syndrome is a dramatical demonstration of this fact. Although it is rare, it is therefore still widely cited for teaching purposes.

Brown-Séquard's work on the spinal cord, which gave him a reputation for unnecessary cruelty to animals, was not his only contribution to science. He was also one of the founders of endocrinology. He showed that the adrenals are vital for life, and conjectured that these organs, as well as the thyroid, pancreas, liver, spleen and kidneys, produced secretions (later to be called hormones) which entered the bloodstream. This gave him the idea for a peculiar treatment: he thought that a fluid prepared from the testicles of sheep would produce rejuvenation, and regularly injected himself with this elixir. This invention made him most famous in the popular press, although it made him ridiculous in the eyes of this colleagues. Besides, his fellow-scientists criticized his work on the adrenal glands because he did not make a step-by-step analysis of the way in which their removal led to the death of the animal.

Brown-Séquard performed many other experiments. We only mention his work on rigor mortis, the action of the vasomotor nerves and artificially induced hereditary epilepsy. He must have been one of the most tireless investigators that ever lived. In the course of his restless life (he crossed the Atlantic more than sixty times), he actively contributed to the founding of medicine as an academic discipline in the United States. Although his main work was carried out in France, he held positions in Richmond (Virginia), Boston and Harvard, and lectured widely in the rest of the country.

Although Koehler's book is called The concept of localization in Brown-Séquard's neurology, it is by no means restricted to this topic. The largest part of the book is devoted to a biography of Brown-Séquard, a description of his experimental work and a discussion of the positions of his predecessors (starting with Pythagoras) and contemporaries. However, these sections could as well have been left out. Koehler does not seem to adduce any new material, even though he visited various archives to study unpublished manuscripts.

As a result of the disproportionally large attention to matters which can be found in any of the several good existing biographies, less than fifty pages remain for a discussion of Brown-Séquard's concept of localization and less than twenty for a survey of the influence of his ideas on later neurologists. To my mind, these pages are not very exciting either.

Koehler sketches the following picture. Brown-Séquard was opposed to the outspoken localisateurs, their main representative being Charcot, who thought that brain functions could be localized in rather well-circumscribed regions. Instead, he held that cells performing a certain function may be scattered over a wide region of the nervous system. These cells may perform action at a distance: they may excite or inhibit activity in distant regions of the brain. Motor aphasia is a good example of this phenomenon. The fact that this syndrome is caused by lesions in Broca's centre does not imply that the ability to produce speech resides there: the damaged area may overstimulate certain other regions which inhibit the capacity to speak.

It is clear that all localization of function becomes doubtful in this way. One of Brown-Séquard's conclusions was that the cerebral hemispheres are equipotential: "both brain halves serve both body halves." Another victim of his view was his own earlier work on the localization of the sensory pathways in the spinal cord. He thought that this needed serious revision at least: it is misleading to speak of lateralization of function in the spinal cord.

The final chapter of the book discusses the influence of Brown-Séquard's views on localization in the nervous system on later neurologists. According to Koehler, Goltz and Sherrington were inspired by him. However, I doubt whether this influence, even if it existed, was particularly essential. The principles of excitation (dynamogenesis) and inhibition would have arisen anyhow. And an opposition to strict localizationism is a far too general tenet to be fruitful in itself. Besides, Brown-Séquard went too far in the opposite direction.

In sum, Koehler's book does not seem to be a great addition to the history of neurology. It is ill-balanced; the relatively short section on the concept of localization may merit a translation, but even that will hardly be stimulating for historians or contemporary scientists.

Postscript, July 2000

This is the only book review that I have written with which I no longer agree. I now think that the review was much too harsh.

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