Celebrated father of English neurology

John Hughlings Jackson, who died 100 years ago next Friday, has been called the father of English neurology. He is best remembered for his seminal contributions to the diagnosis and understanding of epilepsy. He described the characteristic “march” of symptoms in focal motor seizures and the so-called “dreamy state” of psychomotor seizures of temporal lobe origin.

But this great neurologist nearly took a different path during his early career working as resident medical officer at the York Dispensary. The young Jackson was influenced by the biologist and social philosopher Herbert Spencer, whose positivistic evolutionary theory led him to certain basic neurological doctrines. The influence of Spencer, who coined the term “survival of the fittest”, made Jackson consider abandoning medicine in favour of philosophy.

Thus, an important part of his work concerned the evolutionary organisation of the nervous system, for which he proposed three levels. At the lowest level, movements are represented in their least complex form, with centres in the medulla and spinal cord, the middle level consists of the motor area of the cortex, and the highest motor levels are found in the prefrontal area.

Jackson went on to become a physician at the London Hospital, the National Hospital for the Paralysed and Epileptic, and Moorfields Eye Hospital. It was at Moorfields that Jackson became familiar with the ophthalmoscope, popularising its use as a diagnostic instrument. He was one of the first to insist on the relationship between ocular and cerebral disease, and began the tradition of neurologists’ association with ophthalmological hospitals.

In 1863 he described Jacksonian epilepsy, the epileptic convulsions that progress through the body in a series of spasms, and in 1875 he traced them to lesions of the motor region of the cerebral cortex. He was the first to propose that certain mental conditions may result from structural brain damage. His interest in seizures possibly stemmed from his experiences with his wife, who was also his cousin, who was an epilepsy sufferer.

Jackson was elected a fellow of the Royal Society in 1878. He was one of the few physicians to have delivered the Goulstonian (1869), Croonian (1884) and Lumleian (1890) lectures to the Royal College of Physicians. Together with eminent neuropsychiatrists Sir David Ferrier and Sir James Crichton-Browne, and mental health reformer Sir John Charles Bucknill, he founded the Brain journal, first published in 1878.