John Hughlings Jackson

John Hughlings Jackson was the son of Samuel Jackson, a yeoman who owned and farmed his land and the former Sarah Hughlings, the daughter of a Welsh revenue collector. His mother died just over a year after giving birth to him. There were three sons and a daughter besides John; his brothers immigrated to New Zealand and his sister married a physician.

Philosophy or medicine?
Jackson attended small country schools, and little is known of this period of his early life, except that he attended schools at Green Hammerton and Tadcaster in Yorkshire as well as a school at Nailsworth in Gloucestershire. At the age of fifteen (or in 1852), 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. In 1856 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 where he was appointed Resident Medical Officer at the York Dispensary.

At the dispensary he worked with Thomas Laycock (1812-1856). Laycock was especially interested in the brain, the conscious state, the spoken word and print, and he was the first person who considered the brain as subject to the laws of reflex action. In his early life Jackson was also influenced by Charles-Édouard Brown-Séquard (1817-1894) and the biologist and social philosopher Herbert Spencer (1820-1903) whose positivistic evolutionary theory led Jackson to certain basic neurological doctrines. Impressed by the writings of Herbert Spencer, who coined the famous term “survival of the fittest", Jackson gave serious consideration to the thought of abandoning medicine in favour of philosophy.

The young doctor
In 1859 Jackson again went to London where Sir Jonathan Hutchinson (1828-1913), also from York, encouraged him to continue with medicine rather than philosophy. With the help of Hutchinson, Jackson started in London as a medical journalist and thus became acquainted with the chief London hospitals. However, already in 1859 he was appointed to the staff of the Metropolitan Free Hospital and at the same time was made lecturer in pathology, morbid anatomy, and histology at the London Hospital Medical School. In 1860 he submitted his doctoral thesis in medicine to St. Andrew's University in Scotland. He could do this while residing in London because at that time students were allowed to receive a Doctorate of Medicine from St. Andrews via correspondence. In 1861 he 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 consultant physician.

Jackson’s other main attachment was to the National Hospital for the Paralysed and Epileptic, Queen Square, London, founded in 1860 with Charles-Édouard Brown-Séquard (1817-1894) as physician-in-chief. It was Brown-Séquard who encouraged Jackson to concentrate his efforts in neurology. Jackson began as assistant physician in 1862, he was elevated to full physician in 1867, and from 1896 to 1906 he was a consulting physician. Jackson also had other appointments to London hospitals, the most consequential being that to Moorfields Eye Hospital from 1861; here he became familiar with the ophthalmoscope, which he popularised in English neurology. Jackson was also affiliated with the Islington Dispensary and 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, in 1868 the Goulstonian lectures. 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.

Neurology - a new frontier
Jackson’s earlier papers deal primarily with ophthalmologic problems. The ophthalmoscope had been invented in 1851 by Hermann von Helmholtz (1821-1894). 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 ophthalmologic hospitals. He was one of the first to insist upon the relationship between ocular and cerebral disease.

Jackson was the first to postulate that abnormal mental conditions may result from structural brain damage, and in 1863 discovered the epileptic convulsions now known as Jacksonian epilepsy, that progress through the body in a series of spasms and in 1875 traced them to lesions of the motor region of the cerebral cortex, or outer layer of the brain. His interest in seizures may have stemmed from his experiences with his wife and cousin who had Jacksonian epilepsy and died at an early age.

In 1864 Jackson confirmed Broca's discovery that the speech centre of right-handed persons is located in the left cerebral hemisphere, and vice versa, by finding that, in most cases, he was able to associate aphasia in right-handed persons with disease of the left cerebral hemisphere.

Although acclaimed as the greatest British scientific clinician of the nineteenth century, Jackson carried out no experiments and rarely employed the microscope. However, he was not isolated from the scientific community. He was widely read in the literature and closely followed the experimental reports of others. Jackson also corresponded with several researchers who used experimental methods, among them David Ferrier (1843-1928) whose research supported some of Jackson's observations.

In 1878 Jackson joined Sir John Charles Bucknill (1840-1897), Sir James Crichton-Brown (1840-1938), and David Ferrier as founder and editor of the famous journal Brain.

In a fit
Before Jackson’s time it was thought that epileptic phenomena originated in the medulla oblongata, and it was his work more than anybody else’s that initiated progress toward the present concept. 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 of muscle».

Studying his wife, Jackson concluded that the epileptic seizures were electrical discharges within the brain. He noted that in many cases the convulsions in epilepsy started in a specific area of the body and then spread throughout the body from the point of origin as convulsions in the originally affected area became increasingly more intense. To Jackson, this suggested that the brain was divided into different sections, and that each section controlled the motor function (or movement) of a different part of the body. And since the pattern never varied, the way the brain is organized must also be set.

One of Jackson’s most outstanding contributions to the neurosciences was his contention that function is localized to areas of the cerebral cortex. By 1870 he was certain of his contention, and it was in the same year that Gustav Theodor Fritsch (1838-1927) and Julius Eduard Hitzig (1838-1907) showed experimentally that electrical stimulation of the cortex produced contralateral limb movements. Working in a makeshift laboratory in Fritsch's house, Fritsch and Hitzig had stimulated the brains of live dogs with galvanic current. They found that not only could they cause crude movements of the dogs' bodies, but that specific areas of the brain controlled specific movements. These results were confirmed by David Ferrier who stimulated the cortex of monkeys. Ferrier dedicated his 1876 book, The Functions of the Brain, to Jackson.

The shy grand man
In 1865 Jackson married his cousin Elizabeth Dade Jackson who suffered from what we now call Jacksonian epilepsy and who died childless of a cerebro vascular disorder in 1876. Both Jackson and his wife died at Manchester square, and his residence there is today recorded on a blue plaque affixed to the house. After his wife died he became a recluse and suffered from vertigo and migraine.

Jackson was a modest, intensely shy man who disliked most social activities and abhorred sports, even walking. He suffered from, migraine, a chronic form of vertigo and progressive hearing deficiency. However, this eccentric man was gentle, courteous, and had a subtle, if somewhat hidden, sense of humour, and never exhibited excess of passion. His intellectual honesty allowed him always readily to acknowledge the efforts of others. He had no religious conviction and denied the existence of life after death. Jackson's only hobby was the reading of novels and even of penny thrillers.

In 1887 Jackson was awarded an Honorary Doctorate of Laws by Glasgow University, in 1904 Doctorate of Science by The University of Leeds, and in 1905 he was awarded an Honorary Degree of Doctor of Laws from The University of Edinburgh.

«The study of the causes of things must be preceded by the study of things caused»

«We have multitudes of facts, but we require, as they accumulate, organisations of them into higher knowledge; we require generalisations and working hypotheses.»

«We have long heard that old maids’ husbands are always well behaved, and on the same principle the pathology of those who do not make post-mortem examination is often confident and definite» British Medical Journal, 1882, 2: 305.

"I have for more than ten years, and before the experiments of Hitzig and Ferrier were made, held that convolutions of contain nervous arrangements representing movements. It is in accordance with this belief that I have long considered chorea, and more lately convulsion, to be movements resulting from 'discharges' of the cerebral cortex"
Selected Writings of John Hughlings Jackson, volume I: On Epilepsy and Epileptiform Convulsions, page 37.

"The higher nervous arrangements evolved out of the lower to keep down those lower, just as a government evolved out of a nation as well as directs that nation. If this be the process of evolution, then the reverse process of dissolution is not only 'a taking off' of the higher, but is at the very same time a 'letting go' of the lower. If the governing body of this country were destroyed suddenly, we should have two causes for lamentation: (1) the loss of services of eminent men; and (2) the anarchy of the now uncontrolled people. The loss of the governing body answers to the dissolution in our patient (the exhaustion of the highest two layers of his highest centres); the anarchy answers to the no longer controlled activity of the next lower level of evolution (third layer)."
Selected Writings of John Hughlings Jackson, volume II: Evolution and Dissolution of the Nervous System, volume II, page 58.

• Observations on defects of sight in brain disease.
  Ophthalmic Hospital Reports, London, 1863-1864, 4: 10-19, 389-446.
  Ophthalmic Hospital Reports, London, 1865-1866, 5: 51-78, 251-306.
  In this work Jackson showed the importance of the ophthalmoscope in the investigation of diseases of the nervous system. Reprinted in Medical Classics, 1939, 3: 918-926.
• Loss of speech: its association with valvular disease of the heart, and with hemiplegia on the right side. Defects of smell. Defects of speech in chorea. Arterial regions in epilepsy.
  Clinical lectures and reports by the medical and surgical staff of the London Hospital, 1864, 1: 388-471.
  Jackson studied aphasia for 30 years. he emphasized its psychological aspects and laid the foundation for present knowledge of the condition.
• Notes on the physiology and pathology of language.
  The Medical Times and Gazette, London, 1866, 1: 659-662.
• On a case of muscular atrophy, with disease of the spinal cord and medulla oblongata.
  Written with Jacob Augustus Lockhart Clarke (1817-1880).
  Medico-Chirurgical Transactions, London, 1867, 50: 489-496.
• Case of hemikinesis. British Medical Journal, London, 1875, 1: 773.
• Notes on the physiology and pathology of language 6). Brain, 1915, 38: 65-71.
  
• On affections of speech from disease of the brain79). Brain, 1915, 38: 107-129.
  Jackson's papers on affections of speech, reprinted and commented by Sir Henry Head (1861-1940).
• Remarks on the relations of different divisions of the central nervous system to one another and to parts of the body.British Medical Journal, 1898, 1: 65-69.
• Neurological Fragments of J. Hughlings Jackson.
  Edited by James Taylor. 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.
• Selected Writings of John Hughlings Jackson.
  Edited by James Taylor (1859-1946) 2 volumes, London, 1931
  Volume I:
• On Epilepsy and Epileptiform Convulsions.
  Volume II:
• Evolution and Dissolution of the Nervous System. Speech. Various Papers, Addresses. Bibliography. First published 1881-1887. Various:
• Loss of speech, with hemiplegia of the right side.
  Ophthalmic Hospital Reports and Journal of the Royal London Ophthalmic Hospital, London. Volume 1, 1857.
• Defects of sight in brain disease. Ophthalmic Hospital Reports, London.
• Ophthalmoscopic examination during sleep. Ophthalmic Hospital Reports, London
• Epileptiform amaurosis.Convulsion. In: Sir John Russell Reynolds (1828-1896), publisher: A System of Medicine, volume II. London, Macmillan & Co., 1868.
• Apoplexy. In: Sir John Russell Reynolds, publisher: A System of Medicine. Volume II. London, Macmillan & Co., 1868.
• Disease of both lobes of the cerebellum. The Medical Mirror, London. Volume 6, 1869.
• Diseases of nervous system from inherited syphilis.
  Transactions of the St. Andrew's Medical Graduates' Association, London.
• A study of convulsions.
  Transactions of the St. Andrew's Medical Graduates' Association, London. In West Riding Lunatic Asylum Reports, Volume III 1873, IV 1874, and V 1875.
  
• On the localization of movements in the cerebral hemisphere.
  
• On the investigation of epilepsies.
  
• On a case of recovery from optic neuritis.
  
• On temporary mental disorders after epileptic paroxysms.
• Syphilitic affections of the nervous system.
  Journal of Mental Science, London, volume 20, 1875.
• Eye symptoms in locomotor ataxy and in optic neuritis.
  Transactions of the Ophthalmological Society of the United Kingdom, volume I, 1881.
• Epileptiform convulsions from cerebral disease.
  Transactions of the International Medical Congress, 1881. Bibliography from 1861 to 1894 in London Hospital Gazette, 1894. Works by others:
• T. Laycock:
  Analytical essay on irregular and aggravated forms of hysteria. The Edinburgh Medical and Surgical Journal, 1839, 52: 43-86. On the reflex function of the brain.
  British and Foreign Medical Journal, 1845, 19: 298-311 On the reflex function of the brain: a correction of dates.
  The British Medical Journal, May 1874, 705-706. Reflex, automatic and unconscious cerebration; a history and a criticism.
  The Journal of Mental Science, 1876, 21: 477-498.
  Thomas Laycock was the first person to apply the concept of reflex action to the brain
• Pierre Paul Broca (1824-1880):
  Perte de la parole; ramolissement chronique et destruction partielle du lobe antérieur gauche de cerveau.
  Bulletins de la Société d’anthropologie de Paris, 1861, 2: 235-238.
• David Ferrier:
  The Croonian Lectures on Cerebral Localisation.
  Royal College of Physicians of London, 1874. The Function of the Brain. London, 1876.
  French translation: Les fonctions du cerveau. Paris, 1878. VIII + 519 pages.
  German translation by Heinrich Obersteiner: Die Functionen des Gehirnes. Braunschweig, 1879. On localisation of cerebral diseases. Gulstonian lecture, 1878.
• Julius Eduard Hitzig and Gustav Theodor Fritsch:
  Über die elektrische Erregbarkeit des Grosshirns. Archiv für Anatomie, Physiologie und wissenschaftliche Medicin, Leipzig, 1870, 37: 300-332.
• H. Viets:
  The history of neurology in the last one hundred years.
  Bulletin of the New York Academy of Medicine, 1948, 24: 772-783.
• J. Taylor:
  Selected Writings of John Hughlings Jackson.
  Volumes 1 & 2. London, Staples Press, 1958.
• H. Engelhardt:
  John Hughlings Jackson and the mind-body relation.
  Bulletin of the History of Medicine, 1975, 49: 137-151.
• K. Dewhurst:
  Hughlings Jackson and Neurology. Oxford, England: Sanford Publications, 1982.
• M. Swash:
  John Hughlings-Jackson: A sesquicentennial tribute.
  Journal of Neurology, Neurosurgery, and Psychiatry, 1986, 49: 981-985.
• Barry G. Firkin and J. A. Whitworth:
  J. Hughlings Jackson (1835-1911).
  In: Dictionary of Medical Eponyms. Parthenon Publishing Group. 1989.
• MacDonald Critchley and Eileen A. Critchley:
  John Hughlings Jackson, Father of English Neurology.
  New York, New York: Oxford University Press, 1998.
• L. Harris:
  Early theory and research on hemispheric specialization.
  Schizophrenia Bulletin, 1999, 25 (1): 1-39.
• R. Edward Hogan and Kitti Kaiboriboon:
  The "Dreamy State": John Hughlings-Jackson’s Ideas of Epilepsy and consciousness.
  The American Journal of Psychiatry, October 2003, 160: 1740-1747.