Jackson, John Hughlings
Jackson, John Hughlings
(b.Providence Green, Green Hammerton, Yorkshire, England, 4 April 1835; d. London, England, 7 October 1911)
clinical neurology, neurophysiology.
Jackson’s father, Samuel, was a yeoman who owned and farmed his land; his mother, the former Sarah Hughlings, was of Welsh extraction. There were three sons and a daughter besides John; his brothers emigrated to New Zealand and his sister married a Dr. Langdale. Jackson attended small country schools, and little is known of this period of his life except that his general education was limited. At the age of fifteen he was apprenticed to a Dr. Anderson, a lecturer at the now defunct York Hospital Medical School, and completed his medical education at St. Bartholomew’s Hospital Medical school in London from 1855 to 1856, when he gained the form of English medical qualification usual at that time: Member of the Royal College of Surgeons and Licentiate of the Society of Apothecaries. He then went back to York Hospital as house surgeon to the dispensary, a post he held until 1859, when he returned to London, intending to study philosophy rather than medicine.
Jonathan Hutchinson, also from York, dissuaded Jackson, and he was appointed to the staff of the Metropolitan Free Hospital in 1859 and at the same time was made lecturer on pathology at the London Hospital. In 1860 He took the M.D. degree of the University of St. Andrews and in 1861 was admitted Member of the Royal College of Physicians of London. By 1863 he was assistant physician at the London Hospital and, in 1874, physician; he remained on the active staff until 1894, thereafter until 1911 serving as consulting physician. Jackson’s other main attachment, to the National Hospital for the Paralysed and Epileptic, Queen Square, began in 1862 as assistant physician; elevated to full physician in 1867, he retired in 1906 as consulting physician. Jackson also had other appointments to London hospitals, the most consequential being that to Moor-fields Eye Hospital from 1861; in addition he had a private practice.
In 1868 Jackson was elected a Fellow of the Royal College of Physicians of London, and over the ensuing years he was invited to give several of the important named lectures of the College and to assist in its administration. He was appointed Fellow of the Royal Society in 1878 and in 1885 was the first president of the Neurological Society, later absorbed by the Royal Society of Medicine.
He married his cousin Elizabeth Dade Jackson in 1865; they had no children, and she died of a cerebrovascular disorder in 1876. Both Jackson and his wife died at 5 Manchester Square, and his residence there is today recorded on a blue plaque affixed to the house. He suffered from a chronic form of vertigo and died of pneumonia.
Jackson was an intensely shy, modest, and obsessional man who disliked most social activities. He was gentle, ever-courteous, and had a subtle, if somewhat hidden, sense of humor. He never exhibited excesses of passion, and his intellectual honesty allowed him always readily to acknowledge the efforts of others. He had no religious convictions and denied the existence of life after death.
Much has been written on the fertility of Jackson’s genius, which basically depended upon his ability to diverge and converge. Like his contemporary Charles Darwin, he had the keenest powers of observation and at the same time an ability to manipulate philosophical concepts, together with a comprehensiveness of view. He could on the one hand give laborious attention to the minutest local clinical neurological detail, which he analyzed with infinite care, and on the other he could synthesize and propound wide generalizations and fundamental doctrines involving the whole nervous system. His writings are usually considered difficult to read because of an involved and tedious style, dictated by his obsessive need to qualify and document statements and to repeat himself.
Jackson’s first paper was published in 1861, his last in 1909. Unfortunately he never recorded a systematic account of his views, but his scattered contributions to the neurological sciences can be considered under six specific areas. His writings are voluminous and teeming with ideas, only some of which can be presented here. For most of Jackson’s ideas it is impossible to indicate in a brief summary either their breadth and subtlety or the rich accumulation of diverse clinical phenomena supporting them.
When Jackson first entered the field of clinical neurology, it was a chaotic mass of clinical and pathological data concerning diseases that were usually of unknown etiology. Neurophysiology was also in its infancy. During his lifetime and as a result of the combined activity of neurological clinics mainly in Paris, Heidelberg, Vienna, New York, and Philadelphia and of his own institution in Queen Square, order was established, methods of clinical examination were introduced, etiologies (usually based on advances in physiology or pathology) were discovered, advances in physiology were made, and the roots of modern neurology were created. It was in this milieu that Jackson excelled because of his versatility in the collection of data and the enunciation of basic principles. Although acclaimed as the greatest British scientific clinician of the nineteenth century, he carried out no experiments and rarely employed the microscope; but he was acutely aware of their importance and was widely read in the literature. He was devoted to clinical observation, to the analysis of facts, and to philosophic reasoning.
Thus armed, Jackson profoundly influenced all of the neurological sciences. He applied the data of abnormal functioning to the elucidation of the normal action of the nervous system. Jackson’s creed was as follows: “I should be misunderstood if I were supposed to underrate the physiological study of disease of the nervous system. Indeed, I think that to neglect it shows want of education, but to neglect the clinical shows want of experience and sagacity. Never forget that we may run the risk of being over-educated and yet under-cultivated.” This approach remains acceptable today. He was less concerned with the etiology of disease and its cataloging than with the interpretation of disorders in terms of physiology. Jackson always wished to know how a symptom could reveal normal function and how knowledge of a disease could illuminate the normal dynamic properties of the nervous system. In sum, he profoundly influenced the development of clinical neurology, neurophysiology, and psychology in the nineteenth century and continues to do so in the twentieth.
In early life Jackson was influenced by four men:Thomas Laycock, who introduced him to the Paris school of clinicopathologic correlation and to clinical neurology; Jonathan Hutchinson, who imbued him with the Hunterian tradition of scrupulous observation and biological and pathophysiologic principles; Charles Brown-Séquard, who also influenced him to devote his attention to the nervous system; and Herbert Spencer, whose positivistic evolutionary theory led Jackson to certain basic neurological doctrines.
Jackson’s earlier papers deal primarily with ophthalmological problems. The ophthalmoscope had been invented in 1851 by Helmholtz;and when Jackson began his neurological career ten years later he emphasized its importance as a diagnostic instrument and the need for neurologists to study eye diseases. In London he began a tradition, which still exists, of neurologists being affiliated with ophthalmological hospitals. He was one of the first to insist upon the relationships between ocular and cerebral disease and wrote extensively on papilledema and “optic neuritis”;he published a summary of his work in 1871 and also wrote many papers on ocular palsies. Jackson’s contribution to the growth of ophthalmology and neuro-ophthalmology was therefore a significant one, and it continued throughout his career.
Before Jackson’s time it was thought that epileptic phenomena originated in the medulla oblongata, and it was his work more than anyone else’s that initiated progress toward the present concept. He considered each attack to be an experimental situation from which, by close observation and deduction, he could add to the knowledge of the functioning of the normal brain. At a physiological level he considered a convulsion to be a symptom, not a disease per se: “an occasional, an excessive and a disorderly discharge of nerve tissue on muscle.” The word “discharge” was an inspired forecast of electrical phenomena. Jackson was the first to place the site of this disturbance in the cerebral cortex; and from his careful analysis of the localized type of epilepsy, with its “march” of events, as he put it, he deduced that in this case it was limited to a certain area of one cerebral hemisphere. This focal fit, or convulsion beginning unilaterally, had been described earlier by L. F. Bravais (Recherches sur les symptómes et le traitement del’épilepsie hémiplégique, Thèse de Paris, no. 118 ) and by others, but its significance had remained unknown; it is therefore appropriately termed “Jack-sonian epilepsy.”
Each local epileptic manifestation received Jackson’s attention; and he is also well known for the first adequate account of the uncinate fit, which involves a “dreamy state,” a hallucination of smell or taste, and involuntary chewing or tasting. The loss of consciousness associated with the major (grand mal) and the minor (petit mal) varieties of epilepsy also intrigued him; he was able to demonstrate that it was due to a wide spread of the discharge. Concerning the etiology of epilepsy he often found no pathological change and suggested a nutritional disturbance of brain cells, which may be the explanation in certain cases. Jackson’s interest in epilepsy led him to several important discoveries in neurophysiology, the most significant being cortical localization and speech function.
One of Jackson’s most outstanding contributions to the neurosciences was his contention that function is localized to areas of the cerebral cortex. This he deduced from his studies on focal epilepsy and from philosophical considerations, here clearly being influenced by Herbert Spencer and supplementing the work of Broca. By 1870 he was certain of his contention, and it was in the same year that Fritsch and Hitzig showed experimentally that electrical stimulation of the cortex produced contralateral limb movement. Others quickly verified this; but the most important confirmatory study was that of Ferrier, whose aim was to test Jackson’s suggestion fully. Jackson believed in neither precise cortical mosaics nor diffuse representation; but in the case of the representation of movements, he postulated a motor area and worked out the cortical pattern accepted today, noting its gradations and overlapping. His views were not widely accepted at the time but are nearer to modern beliefs than are those of his contemporaries.
Jackson’s study of epileptics whose attacks involved a disturbance of speech allowed him to investigate the physiology of speech, particularly its central mechanisms. Unlike his contemporaries, who were seeking precise cerebral centers for the various manifestations of speech function, Jackson preferred to elucidate its physiological basis. He concluded that there ware two components of speech. First was interlectual or “propositioning” speech, the unit of which is the proposition with precise word order, and not the word, although a single word may have a propositional value if, when it is uttered, other words are understood. Second was emotional speech, which expresses feelings but has no propositional value. As Walshe has pointed out, this simple analysis may be nearer the truth than many modern approaches. Jackson’s suggestion concerning the respective roles of the two cerebral hemispheres in the production and control of speech is no longer acceptable.
The various motor defects manifested by neurological disease provided Jackson with further data to expand his basic concepts of nervous system activity. The focal motor epileptiform attack, the multifarious phenomenon of hemiplegia, and the complex, involuntary movements of chorea were each employed to contribute in particular to his ideas on the functioning of the cerebral cortex and the cerebellum. He considered that the latter controlled continuous (tonic) movements, whereas the cerebrum controlled changing (clonic) movements, and thereby formulated the modern doctrine of the tonic nature of cerebellar activity. In addition, Jackson envisaged functional localization in the cerebellum, which has been demonstrated only very recently. His so-called “cerebellar attacks,” occurring with tumors of the cerebellum, were of brainstem origin.
Jackson’s most basic neurological concept, the evolution and dissolution of the nervous system, again reveals the influences of Spencer and Laycock; the best account of it is in his Croonian lectures (1884). The nervous system evolves from the lowest, simplest, and most automatic center, present at birth, to the highest, most complex, and voluntary. There are three morphological and functional levels: the spinal cord and brainstem, the long afferent and efferent tracts (including their cortical connections), and the prefrontal cerebral cortex. Disease results in dissolution, the reverse of evolution; and there are always two elements present in the clinical picture: the negative, due to local destruction, and the positive, produced by the surviving tissue, which may have been released from higher control.
I. Original Works. Jackson’s writings comprise approximately 320 articles which relate exclusively to clinical neurology and neurophysiology. He attempted no synthesis or opera omnia, despite the entreaties of Osler, Weir Mitchell, and J. J. Putnam (see Neurological Fragments [below], p.25). there are, however, two collections of his works, both edited by J. Taylor—Selected Writing s of John Hughlings Jackson, 2 vols.(London, 1931); I, On Epilepsy and Epileptiform Convulsions, and II, Evolution and Dissolution of the Nervous System. Speech. Various Papers, Addresses and Lectures, with bibliography in II, 485-498; and Neurological Fragments of J. Hughlings Jackson (London, 1925), a series of brief articles published originally in Lancet over a period of sixteen years, all dealing with clinical and physiological neurology and each written in Jackson’s characteristic style. In Medical Classics, 3 (1939), 889-971, there is a bibliography on pp. 890-913; and four of his papers are reprinted on pp. 918-971.
The important contributions are as follows, arranged by topic:
General features of his work are presented in Neurological Fragments (see above); “Notes on the Physiology and Pathology of the Nervous System,” in Selected Writings, II, 215-237; “Certain Points in the Study and Classification of Diseases of the Nervous System,” ibid., pp. 246-250, the Goulstonian lectures, 1869 (abstract only); and “On the Study of Diseases of the Nervous System,” in Brain, 26 (1903), 367-382.
Secondary literature in this area is E. F. Buzzard, “Jackson and His Influence on Neurology,” in Lancet (1934), 2 , 909-913; and S. H. Greenblatt, “The Major Influences on the Early Life and Work of John Hughlings Jackson,” in Bulletin of the History of Medicine, 39 (1965), 345-376, with a bibliography of his writings from 1861 to 1864.
Ophthalmology is the subject of “Lectures on Optic Neuritis From Intracranial Disease,” in Selected Writings, II, 251-264; “Ophthalmology in Its Relation to General Medicine,” ibid., pp. 300-319; and “Opthalmology and Diseases of the Nervous System,” ibid., pp. 346-358.
See B. Chance, “Short Studies on the History of Ophthalmology. III. Hughlings Jackson, the Neurologic Ophthalmologist, With a Summary of His Works,” in Archives of Ophthalmology, 17 (1937), 241-289, with a bibliography of his ophthalmological papers; and J. Taylor, “The Ophthalmological observations of Hughlings Jackson and Their Bearing on Nervous and Other Diseases,” in Proceedings of the Royal Society of Medicine, 9 (1915), 1-28.
“A Study of Convulsions,” in Selected Writings, I 8-36, is the best collection of Jackson’s views on the underlying mechanisms of epilepsy. See also “On the Anatomical, Physiological, and Pathological Investigations of Epilesies,” ibid., pp. 90-111; “On the Scientific and Empirical Investigation of Epilepsies,” ibid., pp. 162-273; and “Epileptic Attacks With a Warning of a Crude Sensation of Smell and With the Intellectual Aura (Dreamy State). . .” ibid., pp. 464-473.
Commentaries are H. L. Parker, “Jacksonian Convulsions: An Historical Note,” in Journal-Lancet, 49 (1929), 107-111; O. R. Langworthy, “Hughlings Jackson: Opinions Concerning Epilepsy,” in Journal of Nervous and Mental Diseases, 76 (1932), 574-585; G. Jefferson, “Jacksonian Epilepsy: Background and Postscript,” in Post-Graduate Medical Journal, 11 (1935), 150-162; and O. Temkin, The Falling Sickness: A History of Epilepsy From the Greeks to the Beginnings of Modern Neurology (Baltimore, 1945), pp. 288-323.
Cortical localization in discussed in “Loss of Speech,” in Clinical Lectures and Reports of the Medical and Surgical Staff, London Hospital, 1 (1864), 388-471; “On the Anatomical and Physiological Localisation of Movement in the Brain,” in Selected Writings, I, 37-76; “Observations on the Localisation of Movements in the Cerebral Hemispheres, as Revealed by Cases of Convulsion, Chorea, and ‘Aphasia,’” ibid., pp. 77-89; and “On Some Implications of Dissolution of the Nervous System,” ibid., II , 29-44.
See E. Hitzig, “Hughlings Jackson and the Cortical Motor Centres in the Light of Physiological Research,” in Brain, 23 (1900), 544-581; and E. Clarke and C. D. O’Malley, The Human Brain and Spinal Cord (Berkeley-Los Angeles, 1968), pp. 499-505.
On speech disorders, see “On the Natural of the Duality of the Brain,” in Selected Writings, II, 129-145; and “On Affection of Speech From Disease of the Brain,” ibid., pp. 155-204.
Secondary writings are Sir Henry Head, “Hughlings Jackson on Aphasia and Kindred Affections of Speech,” in Brain, 38 (1915), 1-190; and “Hughlings Jackson,” in Aphasia and Kindred Disorders of Speech, I (Cambrige, 1926), 30-53; and McD. Cirtchely, “Jacksonian Ideas and the Future With Special Reference to Aphasia,” in British Medical Journal (1960), 2 , 6-12.
Motor functions are discussed in “Observations on the Physiology and Pathology of Hemi-Chorea,” in Selected Writings, II, 238-245; “On Certain Relations of the Cerebrum and Cerebellum. . .” ibid., pp. 452-458; on the cerebellar attitude and attacks, see Brain, 29 (1906), 425-440, 441-445.
See Sir Victor Horsley, “On Dr. Hughlings Jackson’s Views of the Functions of the Cerebellum as Illustrated by Recent Research,” in Brain, 29 (1906), 446-466, the Hughlings Jackson lecture (1906); and E. Clarke and C. D. O’Malley, The Human Brain and Spinal Cord (Berkeley-Los Angeles, 1968), pp. 689-690.
On evolution and dissolution of the nervous system, see “The Croonian Lectures on Evolution and Dissolution of the Nervous System,” in Selected Writings, II , 45-75; “Remarks on . . .,”.,ibid pp. 76-118; and “Relations of Different Divisions of the Central Nervous System to One Another and to Parts of the Body,” ibid., pp. 422-443, the first Hughlings Jackson lecture (1897).
Secondary writings are O. Sittig, “Dr. Hughlings Jackson’s Principles of Cerebal Pasthology,” in Post-Graduate Medical Journal, 11 (1935), 135-138; W. Riese, “The Sources of Jacksonian Neurology,” in Journal of Nervous and Mental Diseases, 124 (1956), 125-134; and Walshe (see below), pp. 127-130.
II. Secondary Literature. In addition to the works listed above, the folowing can be especially recommended:“Obituary. John Hughlings Jackson, M.D. St. And., F.R.C.P. Lond., L.L.D., D.Sc., F.R.S.,” in Lancet (1911), 2 , 1113-1107, with portrait; “Obituary. John Hughlings Jackson, M.D., F.R.C.P., F.R.S.,” in British Medical Journal (1911), 2 , 950-954, with portrait; J. Hutchinson, “The Late Dr. Hughlings Jackson: Recollection of a Lifelong Friendship,” ibid., pp. 1551-1554, repr. in Neurological Fragments, pp. 28-39; C. A. Mercier, “The Late Dr. Hughlings Jackson: Recollections,” in Neurological Fragments, pp. 40-46; J. Taylor, “Jackson, John Hughlings (1835-1911),” in Dictionary of National Biography, Supp., (1901-1911, II, 356-358; and “Biographical Memoir,” in Neurological Fragments, pp. 1-26.
See also (listed chronologically) W. Broadbent, “Hugh-lings Jackson as Pioneer in Nervous Physiology and Pathology,” in Brain, 26 (1903), 305-366 (some of discussion is out of date); A. W. Campbell, “Dr. John Hughlings Jackson,” in Medical Journal of Australia (1935), 2 , 344-347; W. G. Lennox, in W. Haymaker, ed., The Founders of Neurology (Springfield, III., 1953), pp. 308-311;W. Riese and W. Gooddy, “An Original Clinical Record of Hughlings Jackson With an Interpretation,” in Bulletin of the History of Medicine, 29 (1955), 230-238, a case of grande hysterie seen in 1881; Gordon Holmes, in K. Kolle, Grosse Nervenārzte; Lebensbilder, I (Stuttgart, 1956), 135-144; McD. Critchley, “Hughlings Jackson, the Man:and the Early Days of the National Hospital,” in Proceedings of the Royal Society of Medicine, 53 (1960), 613-618; F. M. R. Walshe, “Contributions of John Hughlings Jackson to Neurology; A Brief Introduction to His Teaching,” in Archives of Neurology and Psychiatry (Chicago), 5 (1961), 119-131; and E. Stengel, “Hughlings Jackson’s Influence in Psychiatry,” in British Journal of Psychiatry, 109 (1963), 348-355.
In Medical Classics, 3 (1939), 913-914, there is a list of thirty-seven biographical articles, fourteen of which are cited above.