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The Goltz–Ferrier debates and the triumph of cerebral localizationalist theory

Objective: To analyze the significance of the Goltz–Ferrier debates held at the International Medical Congress of 1881 for the development of ideas on cerebral localization. Background: Cerebral localization was the subject of vigorous debate throughout the 19th century. At the Congress of 1881, David Ferrier, a leading proponent of cerebral localization, and Friedrich Leopold Goltz, an equally prominent anti-localizationist, had the opportunity to present their experimental research before 3,000 of the world’s leading medical figures. Methods: The authors reviewed and translated the presentations by Goltz and Ferrier at the Congress and supporting publications in contemporary medical journals. Results: In his presentation to the Physiology Section, Goltz criticized localizationists for their widely divergent conclusions about the exact anatomic sites of cortical centers and for their failure to adequately explain functional restitution after cortical ablations. He noted that localizationist theories could, like an apple, “look very tempting and still have a worm inside.” He described his own studies on massive decerebrations in dogs and noted that despite complete destruction of the cortices of both hemispheres these animals failed to exhibit motor weakness or deficits in primary sensation. Ferrier noted that Goltz’s results were irreconcilable with his own experiments in monkeys, in which circumscribed lesions produced clear and reproducible functional deficits. Both investigators exhibited animals with cortical ablations. Ferrier’s presentation of a hemiplegic monkey prompted Charcot’s famous utterance, “C’est un malade!” [“It’s a patient!”]. A distinguished committee examined the brains of the animals, and confirmed that Ferrier had indeed succeeded in producing a circumscribed lesion in the frontoparietal cortex, whereas the cortical ablations in Goltz’s dogs were much less widespread than anticipated. Conclusions: Ferrier’s dramatic demonstration of the effects produced by localized lesions in macaques triumphed over Goltz’s unitary view of brain function, providing a major impetus for the subsequent successful development of neurologic surgery.