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Alexia and agraphia

Contrasting perspectives of J.-M. Charcot and J. Hughlings Jackson

From the Departments of Health Research and Policy (Epidemiology) and Neurology and Neurological Sciences, Stanford University, CA.

Address correspondence and reprint requests to Dr. Victor Henderson, Stanford University, 259 Campus Drive, mc 5405, Stanford, CA 94305-5405 vhenderson{at}stanford.edu.

Objective: To evaluate 19th-century concepts of cerebral localization for complex mental activities, focusing on alexia and agraphia in published writings of Jean-Martin Charcot (1825–1893) and John Hughlings Jackson (1835–1911).

Background: In the early 1860s, Broca's reports on a special role for the left frontal lobe in articulate language ignited frenetic interest in cerebral localization. Disorders of written language (alexia and agraphia) were enmeshed in ensuing discussions of how the brain was organized for language and other complex behaviors.

Design/Methods: Focused review and analysis of Charcot's and Hughlings Jackson's publications on aphasia, alexia, and agraphia.

Results: In the wake of Broca's observations, the extent to which language functions in general—or such specialized functions as reading and writing—might involve focal cerebral representation was controversial. Based on his clinical–pathologic approach to "regional diagnosis," Charcot came to value insights provided by "partial isolated aphasias." He described patients with isolated alexia and agraphia, and he proposed a functional–anatomic framework to accommodate these disorders. Adopting a hierarchical model of nervous system organization, Hughlings Jackson argued that reading and writing could not be dissociated from other aspects of "intellectual language." Charcot's reductionism was typical of his era, but Hughlings Jackson's more holistic approach was to gain ascendancy in early decades of the 20th century.

Conclusions: Charcot's and Hughlings Jackson's positions on alexia and agraphia reflected contrasting philosophical approaches to the study of brain disorders. Their views informed the opinions of their contemporaries and neurologic heirs in important debates on cerebral organization.

Supplemental data at www.neurology.org.

Presented at the 59th annual meeting of the American Academy of Neurology; Boston, MA; May 2, 2007. Recipient of the 2007 Lawrence C. McHenry Award of the American Academy of Neurology.

Received May 7, 2007. Accepted in final form July 19, 2007.

Disclosure: The author reports no conflict of interest.