Remarks on the diagnosis and treatment of diseases of the brain : delivered at a meeting of the Worcestershire and Herefordshire, Bath and Bristol, and Gloucestershire branches / by J. Hughlings Jackson.

  • Jackson, John Hughlings, 1834-1911.
Date:
[1888]
Catalogue details

Licence: Public Domain Mark

Credit: Remarks on the diagnosis and treatment of diseases of the brain : delivered at a meeting of the Worcestershire and Herefordshire, Bath and Bristol, and Gloucestershire branches / by J. Hughlings Jackson. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

    14/32 (page 12)
    vertigo is often used as a name for a slight lit of epilepsy, even when there is no vertigo at all, no apparent movement of external objects, and no feeling of the patient turning. I use it as a name for vertigo at the onset of epileptic attacks; sometimes it is for a time almost the whole of a seizure, and is afterwards the warn- ing. This is the most serious form of vertigo; the treatment is for epilepsy. (4) I have slender respect for the hypothesis that a stomach disorder sometimes produces a paroxysm of vertigo. If there be such a thing as stomach vertigo, it is the most difficult of the four kinds of vertigo to explain. The question is, How does a dyspeptic attack produce a sudden attack of vertigo? Hence I put it last on the list for particular study. When a man has a paroxysm in which objects seem to move to one side (when the vertigo is, as Gowers puts it, definite ), I certainly do not believe that any kind of digestive disorder is the real cause of the paroxysm; the hypothesis is then too heavy for practical purposes. No doubt most cases of so-called stomach vertigo* are cases of aural vertigo, the attacks being sometimes brought on by dyspepsia. As to treatment, one of course treats dyspepsia in whatever association one rinds it. I now start from a new line of thought—not, however, altogether leaving the subject of study of diseases by type. I have just been urging that we should take up for particular study cases in the order of their simplicity. Were I to write a book I should follow this plan; for the ambitious aim of the work would be to help people in practice to examine for them- selves in scientific ways for practical ends. We cannot learn for ourselves if we begin with complex problems; if we do, we shall run the risk of making vague, and often verbal, explanations. Cases of gross organic brain diseases (such, I mean, as tumours, masses, lumps) are among the simplest of all cerebral diseases. Simple and serious are not, as I have recently been urging and trying to illustrate, convertible terms. Cases of gross organic disease of the brain are far simpler for diagnosis, prognosis, and even, in some ways, for treatment, than are cases of what are called the neuroses (chorea, epilepsy proper, neuralgia, etc.). Of the former we know a great deal and speculative* little ; of the pathology of the latter we know nothing certain and speculate much. Very confident opinions—really hypotheses—are expressed as to the causation and pathology, in particular cases, of the neuroses when we are diffident in the diagnosis of intra-crauial tumour in very many cases. But before we speak confidently of I the causation and pathology of cases of hysteria, epilepsy, chorea, , neuralgia, cases without a known morbid anatomy, we should discipline ourselves by a study of cases in which necropsy is likely to confront us. A post-mortem examination tells us can- didly what our powers of clinical investigation are worth in the case examined. I am speaking of the anatomy, physiology, and pathology of the neuroses {vide infra). I have small faith that any great good will come of the studies of these diseases by those who have not previously disciplined themselves by careful work on what I may be permitted to call the coarser diseases of the nervous system, and who have not before that a good knowledge of recent physiology. It may be objected that the study of cases of gross organic inf ra-cranial disease is dismally fruitless, as we can do very little for the sufferers from it. I believe that we may do very much, even when the tumour is non-syphilitic. For many of the sym- ptoms of tumour are really symptoms of an encephalitis, or cer-