Epilepsy, paralysis and aphasia: The influence of Jabez Spence Ramskills
(1824-1897) on John Hughlings Jackson
Much of the work on John Hughlings Jacksons early years of development point to the influences of Jonathan Hutchinson and Charles Edward Brown-Siquard (e.g., Critchley, 1998 and Greenblatt, 1970). These men are credited both with influencing Jacksons choice of focus on neurological disorders, and the appointments he secured at the National Hospital in Queen Square and the London Hospital. There is another figure who has until now remained in the background. He appears to have been significant in providing the opportunity and context which led Jackson to make his innovative and insightful theoretical advances in the understanding of higher cerebral function disorders.
Jabez Spence Ramskill (1824-1897), born in the same year as Broca, was 10 years Jacksons senior. In the 1860s, Ramskill was Physician and Lecturer in Medicine at the London Hospital, Physician at the Metropolitan Free Hospital, and the first member of staff of a new specialist hospital in Queen Square. It was Ramskill who was responsible for persuading the founders to include epilepsy as focus for the National Hospital which was originally conceived to provided exclusively for those suffering from paralysis. Ramskill was also instrumental, along with Hutchinson and Brown-Siquard, in gaining Jackson each of his appointments: at the National Hospital as his assistant in 1862, at the Metropolitan Free Hospital, and later at the London Hospital as both physician and lecturer. In addition, Ramskill was a significant source of case material upon which Jacksons earliest ideas on the function of the nervous system were based. Ramskill was responsible for the caseload at the National Hospital which grew from 8 inpatient beds in 1860 to include over 8,000 outpatients by 1868.
As assistant physician to Ramskill at the National Hospital, Jackson was provided with the vast case series which provided the source of inspiration for his work on the heirarchical organization of the nervous system. While Ramskills concerns were primarily focussed on patient care and efficacy of treatment, he provided a context for Jacksons more theoretical work on epilepsy, hemiplegia and aphasia. The early writings and case notes of Ramskill and Jackson provide evidence for the close link of interests between the two, and the debt that Jackson had to Ramskill for providing him with the opportunities to develop his original ideas.
Session V -- Hughlings Jackson
Los Angeles, California, USA