Hughlings Jackson's neurological method

George K. YORK and David A. STEINBERG
Kaiser Permanente Stockton Medical Center and the Såa Institute, Fiddletwon, California, USA

This study aims to show the development of John Hughlings Jackson’s method of case analysis. Physicians in mid-Victorian England did not use a systematic method of clinical case study. Many, but not all, followed Moritz Romberg’s 1840 classification of neurological diseases into disorders of increased and decreased sensation and movement. Robert Bentley Todd and Charles Edouard Brown-Séquard advocated an inherently physiological approach to analysis of sensory and motor signs and symptoms. We examined Hughlings Jackson’s published works up to his lecture on the method of study of diseases of the nervous system, given at the London Hospital in June 1864. In his first papers, he collected cases of patients with similar diseases in different anatomical locations, and therefore had different symptoms. Under Brown-Séquard’s influence, he then collected cases with different pathology in the same anatomical location. He became dissatisfied with this method because it did not lend itself to the study of physiology, and he was interested in learning how the nervous system works. He therefore turned to collecting cases with the same anatomy, tissue pathology and symptoms, assuming that a patient’s symptoms indication normal and abnormal physiology. His method of collecting cases of patients with what we now call focal lesions was a scientific method that had not been previously applied to neurology. It proved a durable technique. Hughlings Jackson himself showed the power of his method by publishing a series of thirty-eight patients with mitral stenosis, middle cerebral artery embolism, aphasia and right hemiparesis. This study supported Broca’s assertion that there is a center for language in the left inferior frontal lobe. Hughlings Jackson went on to use his tripartite method of scientific case analysis to produce his theory of cerebral localization.

Session XI -- The Makers and Shapers of Neuroscience
Tuesday, 29 June 2004, 9:30 am

Ninth Annual Meeting of the International Society for the History of the Neurosciences (ISHN)

Montreal, Quebec, Canada