▎WuXi AppTec content team editor
In the era of evidence-based medicine, it is almost difficult for individual case studies to provide much research value, and scientists often need large randomized clinical trials or meta-analyses to link specific conditions to basic molecular theories.
But seventy or eighty years ago, when medicine was not yet developed, the Spanish neuroscientist Justo Gonzalo studied the specific symptoms caused by brain damage in a patient as a field doctor and proposed a theory of neuroscience that was contrary to the concept of the time. Years later, Dr. Gonzalo's daughter has resurfaced these stories in the academic journal Neurologia, giving us a glimpse of the precious connection between doctors and patients and the breakthroughs they brought during the war-torn years.
Dr. Justo Gonzalo (Image: Wikipedia, CC BY-SA 4.0)
Field Doctor with Patient M
Born in Barcelona, Gonzalo has been exposed to medical knowledge since high school, and after further his studies, he returned to the Madrid General Hospital to engage in clinical research in neurology. However, the quiet did not last long, and with the outbreak of the Spanish Civil War, Gonzalo was sent to the front as a field doctor, and the fighting intensified, bringing in a large number of wounded people in the hospital, some of whom suffered serious brain injuries.
During this time, Dr. Gonzalo met with a particular patient, whom he referred to in his report as M. Due to the impact of the bullet or fragment, two obvious wounds appeared in the back of the head of patient M, indicating that the impact had passed through the brain. At the field hospital, patient M experienced a long period of care and recovery, and according to Dr. Gonzalo's records, during the recovery of patient M, he felt that he was blind and could hardly see anything in his left eye.
▲Schematic diagram of brain damage in patient M (Image source: Reference [2])
Dr. Gonzalo performed a variety of tests on patient M and determined that he had developed various problems with his vision, such as triple vision (three images of one object), color interference (separation of color and object), and loss of motor vision.
More notably, in M's eyes, the whole world would be turned upside down: this dislocation could be upside down, or it could be reversed back and forth. In his opinion, people and objects may come to their destination from the opposite side of the reality. When reading text, even if the letters are completely reversed, patient M can read without any obstacles, and he feels that the reverse and positive order of the letter strings are exactly the same.
This illusion allows patient M to read the time of the watch from any angle, but it also gives him a lot of trouble, such as the possibility that he may see the renovation worker stepping on the scaffolding upside down.
Patient M did not change his temperament drastically because of these abnormalities, but accepted it very calmly, and from Dr. Gonzalo's point of view, this is the result of the unconscious development of brain movements and attention mechanisms, so that patient M can adapt to the upside-down world and live normally.
Theories contrary to popularity
After the war, Dr. Gonzalo returned home to Madrid, and as a neuroscientist, he began to construct a completely different theory from the neuroscience of the time, according to the mainstream of the time, the brain was strictly divided into different modules, each with a different function. But this does not explain the phenomenon that patient M's brain is penetrated by an object, but the perception is reversed, and the daily life can still be maintained.
▲ Gonzalo's theory of brain sensory signal gradient (Image source: Reference [2])
In his view, the brain is more like a pattern of overlapping different modules and a decentralized distribution of multiple functions, while neural signals are also like a step, with the density of specific neurons in the cortical region from strong to weak. What symptoms the patient has depends on the location and size of the injury, which also determines how much the signal is destroyed.
He also proposed that these symptoms similar to that of patient M can be summarized by cortical central syndrome, mainly due to multisensory disturbances caused by damage to the apie-occipital symphysis. This also became a very pioneering theoretical achievement at the time, and it was also based on the new knowledge of brain function brought by a single case. Subsequently, Dr. Gonzalo also found that more than 30 patients could be classified as central syndromes.
This theory received a lot of attention in the 40s and 50s of the last century, but it was gradually forgotten by the academic community because it contradicted the mainstream view.
Decades of doctor-patient adventure
But regardless of the theoretical currents, Dr. Gonzalo never forgot his patient M, who traveled between Madrid and Valencia to check him regularly. Without the Institute's subsidy, Dr. Gonzalo initially paid for transportation and lodging himself, a relationship that lasted until his death.
For decades, he often asked patient M about his health and brain problems, and also helped him apply for grants for the war-handed. In 1984, patient M took his son on a trip to Madrid, where the two last saw each other. Before his death, the frail Dr. Gonzalo left a report on his injuries and symptoms during the war for patient M's emergency needs.
In recent years, some studies have begun to re-examine Gonzalo's concept of brain gradients, and many scientists have suggested that this may be one of the basic rules of brain organization, and the theory that has been dusted for decades may once again stand on the scientific stage.
Resources:
[1] Patient M: The Man Who Was Shot in The Head And Woke Up Seeing The World Backwards. Retrieved May 18, 2023 from https://www.sciencealert.com/patient-m-the-man-who-was-shot-in-the-head-and-woke-up-seeing-the-world-backwards
[2] Rediscovering patient M: Justo Gonzalo Rodríguez-Leal and his theory of brain dynamics. Neurology (2023). DOI: https://doi.org/10.33588/rn.7607.2023062