[Dr. John Hughlings Jackson].

Abstract

The great English neurologist, Dr. John Hughlings Jackson was born in Providence Green, Yorkshire, north England, in 1835. He spent his apprenticeship in the city of York, continued his medical education at St. Bartholomew's hospital in London, and qualified in medicine in 1856. After working in the city of York, he studied in London and in 1860 graduated at St. Andrews university in Scotland. He died in London in 1911, famous and celebrated by his colleagues as the "father of British neurology". Jackson was a prolific writer, witty and ingenious person, but also solitary and absent minded, with a lat of "tiny peculiarities of a genius". At first he was committed to become a philosopher but was persuaded by Jonathan Hutchinson, one of his rare friends, to enter medicine. His "Selected Writings" were first published in 1931 and reprinted recently, in 1996, by Arts & Boeve. Jackson, unlike William Richard Gowers, wrote his articles in a style which was not palatable to his contemporary colleagues. This could be the reason that his medical work was not widely known and would have remained in shadow had it not been rediscovered mostly by German neurologists, who preceded their English colleagues and collected the fame. Jackson gave the first classification of epileptic seizures acceptable, to a degree, even today. It was twofold: the first, taxonomic, which corresponds to contemporary classification of seizures, he compared to the attitude of a gardener who classifies flowers according to their beauty, height or color, and was aware of its purely phenotypic, descriptive and utilitarian character; the second was scientific, physiologic and it would correspond nowadays to the current concept of syndromic classification. Jackson was aware that this 'scientific classification' was to await for the future time, when the knowledge of the real nature of epilepsy became fundamentally broadened. On the other hand, he thought that all the epilepsies were partial becoming generalized only secondarily. Partial epilepsies were the starting point in his work. He realized that epileptic attacks are not different types of epilepsies with different pathophysiological mechanisms, but that they differ in respect to the focus of origin; he stressed their gray matter (cortical) arigin with the cause located as the rule "on the side of the brain, opposite to the body convulsed". Jackson's ideas on epileptogenesis and the localization of epileptogenic processes represent his fundamental contribution to the understanding of their pathophysiology. His most philosophical contribution to neurology was the concept of the evolution and dissolution of the nervous system, which was the consequence of his ideas on its organization. Symptoms observed after the lesion of a certain part of the brain are not the consequence of its function; they are the result of the function of the remaining non-lesioned regions which are in a certain way freed from the adjacent or a higher control. This concept of interpretation af the symptoms of the nervous diseases remains applicable even today. Jackson was the first to stress the importance of ophthalmoscopy in neurology in all cases of neurologic disease, especially in cases of optic neuritis (papilloedema) which may be present even if the patient did not notice the minimized visual acuity. The way of thinking that Jackson introduced in medicine and neurology may be his most precious legacy to the generations that followed.