From the archives.

designed by the architects Booth, Ledeboer and Pinckheard, built by the Islington-based construction company Dove Brothers, and formally opened in 1958. While the exterior is comparatively unchanged (Fig. 1), the following photographs from the Institute’s archives (Figs. 2-4), compare the appearance of parts of the interior in 1958 with how they look now. In most cases some original features are still visible. All photographs are copyright of UCL Institute of Archaeology; Stuart Laidlaw took the new photographs. For further information about the Institute’s archives please contact Ian Carroll, Collections Manager. Carroll, I et al 2014 From the Archives. Archaeology International, No. 17: pp. 165-168, DOI: http://dx.doi.org/10.5334/ai.1719

Henry Head  sweeps aside several centuries of erroneous ideas on structure and function of the brain to arrive at 1809 and a first foothold in the saga of 'one of the most astonishing stories in the history of medicine'-cerebral localization. He dismisses any idea that the work of (Franz Joseph) Gall (1758-1828) and his pupil (Johann) Spurzheim (1776-1832) was that of 'quacks . . . responsible for phrenology and the study of bumps on the head'. Gall studied an officer whose frontal lobes were pierced by a foil leaving him with 'a grave disorder of speech'. For Head, the perception that the underlying structure of the brain has an effect on the formation of the skull and that character can be foretold from the external conformation of the head deflected attention from much that was fundamental in Gall's work to novel concepts of the brain as the organ of mind and the physical instrument of morality-grey matter conducting the will, through nerves, to other parts of the body. Later, (Jean-Baptiste) Bouillard (1796-1881) promoted the view that speech and the memory for words are 'localized' in the frontal lobes. It was against this background that (Paul) Broca (1824-80) concluded that two of his patients with altered speech had acquired identical lesions centred on the third frontal convolution. Somewhat uncharitably, (Pierre) Marie (1853Marie ( -1940 pointed out that the first case had an extensive lesion affecting the posterior part of the second and third frontal convolution, the inferior portion of the rolandic area, the first temporo-sphenoidal convolution and the supramarginal gyrus; the second showed only damage to the foot of the second frontal convolution. Paris now divided into localizationists, led by Brouillard, whose liberal views were fiercely opposed by the older conservative school. Broca defended his discovery of 'aphemia' [to his irritation, renamed 'aphasia' by (Armand) Trousseau (1801-67)]: 'the general faculty of language persists . . . the auditory apparatus is intact . . . muscles of the voice and articulation obey the will . . .   (1868; 74: 254-6 and 1868; 75: 263-9); and an abstract of (John) Hughlings Jackson's (1835-1911) statement has been reprinted in Brain (1915;38: 59-64;and see Brain 2008;131: 1658-70 and2011;134: 2791-94). Here, Broca extends his views on cerebral disorders of speech from aphemia to a second disorder-amnésie verbale-in which the patient no longer recognizes the association between ideas and words even though these can be pronounced, 'the special memory . . . of spoken . . . [and] written words . . . is lost'. Broca recognizes that the two clusters of symptoms may coexist; and on the specific localization of these distinct disorders, he is 'confused and indefinite'. Jackson focuses on the distinction between propositional and emotional speech, the latter usually being spared in cerebral disorders. Patients are speechless or, alternatively, have plenty of words but use them wrongly. The issue is not the memory of words or faculty of language that is affected; rather, it is the propositional content of the intellectual task that is exposed by cerebral disorders of speech. Head has no time for the diagrammatic analyses of aphasia that followed Jackson's contributions. (Charlton) Bastian (1837-1915) assumed that we think in words and set a course on the catastrophic road to schemas and diagrams, their simplicity and dogmatism seducing younger generations away from the difficulties and complexities of Jackson's doctrine: 'from this time onwards, the rage for diagrams became a veritable mania'. (Carl) Wernicke (1848-1905) described 'sensory aphasia' due to lesions in the temporal convolution; 'motor aphasia' with damage to the third frontal convolution; and a disorder of the spoken word resulting from lesions of the island of Reil interfering with conduction between these two centres. But Wernicke and others were 'compelled to lop and twist the clinical facts to fit the procrustean bed of their hypothetical conceptions . . . it is difficult to decide whether the clinical obtuseness or want of theoretical insight is more worthy of wonder'. And on the comprehensive diagram of (Ludwig) Lichtheim (1845( -1928( : see Brain 18857: 433-84 and 2006;129: 1347-50): 'serious students could not fit these conceptions of aphasia with the clinical manifestations; incredulous of such scholastic interpretations, they lost interest in a problem of so little practical importance'. doi:10.1093/brain/aws314 Marie returned to the topic in 1906, concluding that Broca had described a complex disorder made up of anarthria due to involvement of the lenticular zone; and aphasia, being a defect of the special intelligence of language, resulting from damage to Wernicke's temporal lobe area. In the heated debate that followed at meetings of the 'Socié te de Neurologie de Paris' on 11 June, and 9 and 23 July 1908, Marie maintained his position, although conceding that 'aphemia' would be an acceptable alternative to 'anarthria', subject to the Society acknowledging that these patients have no disturbance of internal speech; whereas (Jules) Dejerine  argued for retaining the concept of 'Broca's aphasia' (loss of words in speech and writing) and 'total aphasia', in which these features are combined with word deafness and blindness. But consensus could not be reached: 'had the disputants been familiar with the work of Hughlings Jackson, they would have recognised that . . . terms such as "aphasia of Broca", "total aphasia", "word blindness" and "word deafness" were pure phrases, and did not in reality correspond exactly to any clinical phenomena.' Now Head turns to the prescient work of Hughlings Jackson, explaining its lack of recognition through not having been published in prominent journals, the awkwardness of his literary style, and the reluctance to accept ideas that opposed contemporary dogma. Having collected and read all these papers in detail, and also influenced by (Arnold) Pick's (1851-1924) remarkable book Die agrammatischen Sprachstö rungen (1914), Head's synopsis of Jackson's contribution is: (1) Patients with aphasia are either speechless or have plentiful words but use them wrongly; (2) The loss of ability to perform a task to command depends on the complexity of that task; (3) Higher voluntary aspects of speech are more easily affected than lower or automatic oaths and exclamations; (4) Writing is affected as part of the inability to propositionize in words. (5) Inability to read aloud or silently does not imply loss of comprehension for spoken or written commands; (6) Imperception-failure to recognise objects and their purpose-does not necessarily coexist with aphasia; (7) External and internal speech are identical; one leads to utterance of articulated words, whereas the status of internal speech is revealed only by writing; (8) Proposition, the basis for external and internal speech, is necessary for clear and logical thought but not all elements of thinking; (9) Imperception, combined with a defect of speech, results not only in inferior speech but also inferior comprehension; (10) Mental images are unaffected in most disorders of speech. This analysis has led Head to devise a rigorous system for examining patients with aphasia, adopting the principle of setting a similar task that must be executed by different methods; the patient is no longer asked to speak, read or write but to use all these modes of expression to answer the same series of tests (see Fig. 1). 'As . . . I began to apply these methods of examination to patients suffering from aphasia, it became obvious that none of the ordinary theories bore any relation to the facts I discovered; it was not until I had read through a complete series of Jackson's papers that I recognised the importance of the principles he had enunciated . . .' Head's patients are young men with cerebral injuries seen in the Empire Hospital for Officers in Vincent Square (London, UK), established in 1915; they are intelligent and anxious to be examined, encouraged and cheered by their obvious improvements, euphoric rather than depressed, and in every way contrasted with the aphasic patient met in civilian practice. What has been learned? Just because speech is affected by focal lesions of the brain, it does not follow that 'the faculty of speech' is localized in any area of the cortex. No more does a complex act such as speaking correspond to a specific group of functions than does eating. The lesion disturbs certain physiological processes, but no anatomical lesion corresponds exactly to a single group of physiological functions. No lesion produces a disturbance of speech, or any other behaviour, in isolation, and no lesion affects all that constitutes speech. The concepts of 'sensory aphasia', 'alexia', 'agraphia' and 'amnesia verbalis' should be abandoned. An organic lesion disturbs certain physiological processes necessary for the complex acts that underlie the use of language by undermining symbols of constructive thought such as words, numbers and pictures. It follows that any mental process depending on exact comprehension, voluntary recall and expression of such symbols fails in the patient with aphasia. These patients should be considered as having disturbances in 'symbolic thinking and expression'. That said, it is symbols used in a particular manner rather than all symbolic representations that suffer in these disorders. Failure of symbolic action is most easily exposed by complex propositional tasks, especially those in which choice is involved, a sequence of responses required, or abstract reasoning needed to comply; and the patient may circumvent the difficulty by responding to, or with, metaphorical modes of expression. The basis for aphasia is loss of meaning for symbols. By way of illustration, many patients with aphasia will add the number 3 to 6 by 'saying to themselves' 6, 7, 8, 9 rather than the single step of 6 + 3 = 9. Asked to set the hands of a clock at 4.45 pm, a patient with aphasia can place the hour hand at 4 and sweep the minute hand to 45 but cannot deal with the request to indicate 'quarter to five'. When intact, symbolic thinking and expression require easy verbal manipulation; errors of articulation in aphasia are not due to dysarthria but indicate defective conceptions of the structure and rhythmic balance of the symbol, interfering not only with articulated speech but also internal verbalization. Symbolic thought and expression should not be considered as dissolution to a more primitive hierarchical state involved in the development of language reflecting one component out of which it is constructed; but rather as a fundamental element of psychical processes that are disaggregated by focal brain lesions. Careful analysis can reveal those components of the symbolic process that remain intact and those that are rendered isolated and inaccessible. Now, Head reveals his own classification of speech defects based on the Jacksonian doctrine of proposition and his concept of symbolic thought in language.
(1) Verbal aphasia. A disturbance of word formation with slowing of selection and delivery from a restricted vocabulary affecting the articulation and spelling of the spoken and written word; reading is laborious and not pleasurable; calculation is affected but to a lesser degree. This is Broca's 'aphemia' now designated 'motor aphasia'; (2) Syntactical aphasia. A disturbance of rhythm and grammatical coherence with ill-balanced articulation and excessive use of jargon so that meaning is obscured or lost altogether; speech, once started, is voluble and emitted with great rapidity; any attempt to convey a formulated statement ends in confusion; reading and writing are relatively preserved; (3) Nominal aphasia. Words-spoken or written-cannot be understood; actions requiring choice are impaired; counting is relatively spared; 'this form cannot be fitted into any of the older methods of classification . . . it has some of the characters of 'motor aphasia' . . . and other defects [that] would have been attributed to 'sensory aphasia' . . . the separation of word formation from naming and its allied functions is an entirely new feature in the classification of the aphasias'; (4) Semantic aphasia. Unlike those forms that can be described in terms of verbal deficits, 'I have chosen the term "semantic" as a label for this form of aphasia because the affection comprises want of recognition of the full significance or intention of words and phrases . . . meaning escapes him . . . he fails to grasp the final aim . . . of the action . . . he cannot formulate symbolically a general conception . . . he can read and write but the result . . . is inaccurate and confused . . . memory and intelligence remain on a generally . . . high level'.
Head addresses a topic that has grabbed the attention of the acutest human intellects for over 2000 years: 'the results are . . . of no direct practical value to the physician, but they form a fascinating example of the interaction of body and mind . . . the schoolmen answered the eternal riddle in material terms founded on imaginary anatomy . . . philosophers . . . spun their theories out of a priori conceptions . . . physicians . . . entrusted . . . with therapeutic supervision . . . developed an extensive and accurate acquaintance with the anatomy of the brain but employed the fruits of this great advance in knowledge in the service of an obsolete and almost medieval psychology . . . Hughlings Jackson raised the question . . . to a higher plane . . . but he stood alone and medicine turned a deaf ear to his teaching. Today the older psychology is tottering to its grave, and I am proud to think that a long continued and arduous series of researches has led me at last to understand that great empiric philosopher, the founder of English neurology.' Henry Head came late to his work on aphasia, having devoted the earlier part of his career to studies on sensation-pain, the mapping of dermatomes, nerve regeneration (his own) and the basis for altered sensation in disorders of the brain and spinal cord. He believed that his approach to studying sensation could be adapted to cerebral disorders of speech. His work gained momentum during and after the Great War. In addition to the Hughlings Jackson lecture, he published three monumental works on aphasia: two also appeared as articles in Brain ['Aphasia and kindred disorders of speech' (The Linacre lecture for 1920). Brain 1920; 43: 87-165; and 'Speech and cerebral localization' (The Cavendish lecture for 1923). Brain 1923; 46: 355-528] in which he set out in detail his experimental methods and sought an anatomical basis for the disorders he recognized. Later, he extended these formulations in his twovolume monograph of the same title (Aphasia and kindred disorders of speech, 1926) in which Head offers a restatement of his personal attitudes preceded by a survey of the history of aphasia research. Here, he criticizes most other authors, especially the diagrammaticians, has muted praise for Marie; and is unambiguously approving of Hughlings Jackson, Pick and (Kurt) Goldstein .
To mark the centenary of his birth, colleagues at the London Hospital organized a symposium on 31 August 1961 at which Macdonald Critchley (1900-97) reflected on Head's contributions to aphasia. These had started when testing sensation and finding that failure accurately to report narrow separation of two stimuli did not necessarily indicate inability to appreciate simultaneous touch with one or two points of a compass. This stimulated the need to define a general principle of altered neurological function relevant both to sensation and language. Head found no satisfaction in the writings of others. But he was impressed by the views of Hughlings Jackson on the nature of language disorder, and by Arnold Pick. He brought energy, an obsessional trait, erudition, well-honed critical faculties and originality of thought to his eventual analysis of the problem. In the discussion at the Royal Society of Medicine that took place on 11 November 1920, a month after his Hughlings Jackson lecture on 7 October 1920 (see Brain 1920; 43: 412-50), '(James) Collier (1870-1935) was clever and constructive; (Samuel Alexander Kinnier) Wilson (1874-1937) was very Wilsonian; (James) Purves-Stewart (1869-1949) and  Barnes (1875Barnes ( -1955 were not impressive, while (Sir John) Herbert Parsons  was obscure and somewhat irrelevant'. With his emphasis on words, numbers and pictures and his disapproval of the terms aphasia, alexia, agraphia and agnosia, Head emphasized variable speed and accuracy of performance on repeated testing in the patient with a cerebral disturbance of speech, and the importance of rate and severity of onset rather than strict placement of the lesion. In the face of criticism relating to their specificity, Head defended the battery of tests he had designed on the basis that they all probed inner speech. When dissociated states are present, these do not define the primary elements of speech as it has evolved; rather, they represent the break-up of psychical activity. His four categories of speech disorder were not 'crystal clear', and might overlap or prove incomplete in their formulations; but he stuck with and defended the underlying classification. However, despite risking the ridicule of reverting to a strictly localizationist doctrine in his Cavendish lecture, Head attributes verbal aphasia to lesions of the lower part of the pre-and postcentral convolutions; syntactical defects with damage to the upper convolutions of the temporal lobe; semantic aphasia with lesions of the supramarginal gyrus; and nominal aphasia approximating to damage of the angular gyrus. Head remained uneasy with these attempts at precision and had doubts that a focal lesion could interfere with symbolic formulation and expression, being more comfortable with the position that these categories are to some extent metaphorical and hypothetical. He sought a deeper analysis that corresponded to Hughlings Jackson's formulation of propositions; mirrored the analysis of Goldstein in declaring that 'each particular variety of aphasia represents the response of the organism under the changed condition produced by physiological defects'; and anticipated the view of (Alexander) Luria (1902-77) that aphasia is loss of the regulating, directive or pragmatic functions of speech. With due deference, he preferred his synthesis as altered 'symbolic formulation and expression' to Jackson's 'propositionizing'. But this was a mechanism rather than a definition of aphasia; and it assumed that the affected individual is left marooned somewhere along the spectrum of concrete lower-order tasks and those requiring abstraction and propositional activity, leaving the person with aphasia likely to fail in language even though his or her difficulties might sometimes be circumvented and speech, or non-verbal symbolic acts, accomplished in another way. On comprehension, Head made the analogy of discourse between an educated and less-advantaged person, the latter guessing the gist of the conversation based on those selected points that can be understood; so, too, the person with aphasia jumps to conclusions without the benefit of the usual logical steps, and is sometimes right and sometimes wrong. Like a child, patients with aphasia may spell out words or count on their fingers. But Critchley emphasizes that Head did not consider aphasia to represent dissolution of language back to a primitive developmental status-'a palimpsest from which an earlier and primitive text is revealed when the more recent writing is removed'. The mind of the 'aphasiac' is not child-like even if he or she use childish means to overcome the difficulties. Later, in Aphasia and kindred disorders of speech (1926), Head explores the concepts of 'schemata', borrowed from his studies on sensation, recalled and reassembled during propositional speech. Perhaps these are 'memes' or 'engrams' in modern parlance just as his concept of 'vigilance' has its contemporary expression in the realm of 'attention'. Taken together, Critchley is not fully persuaded by Head's writings on aphasia, taking the view that his ideas ranged wide and deep and were sometimes inconsistent, everything being committed to paper without self-censorship. His historical survey was highly selective, and he appeared not to know of the important monograph by (Sigmund) Freud (1856-1939: Zur Auffassung der Aphasien, 1891; English translation, On aphasia, 1953); on this he was castigated by (Ely) Jelliffe (1866-1945) and Ernest Jones (1879-1958. Forty years on, the battery of tests-time consuming and deliberately repetitive; not sensitive to variable linguistic ability in the subject (such as those who are illiterate, writers, orators, artists, musicians or polyglots); and never controlled in normal individuals-has not survived. With time 'symbolic formulation and expression', 'schemata', 'vigilance' and Head's four-stage classification (superior in theory and inferior in practice to its predecessors because it did not cover the clinical facts) have also all disappeared. For Critchley, the topic of Head's Cavendish lecture seems forced, and his position on the anatomy of aphasia unconvincing.
'Head was a sick man when he wrote Aphasia and kindred disorders of speech . . . and we can detect the uncertain touch. It is prolix and repetitive, and in places even contradictory . . . the work would have been greater if condensed into a single volume. Head achieved so much in aphasia that he is remembered . . . more for his failings than his accomplishments. These have been quietly absorbed within the corpus of neurology. Head's faults were the demerits of a constructive and brilliant mind.' That may be so, but, as six articles in the current issue make clear, the nature of language and symbolic thought remains a topic of intense interest in contemporary clinical neuroscience.