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.

    17/32 (page 15)
    there can bo any kind of symptoms without abnormal changes, however slight they may be in some cases (see an able paper by Dr. Allchin, Westminster Hospital Reports, vol. ii). Hence, when speaking of cerebral and cerebellar tumours, and other masses, I used the expression gross organic disease, not doubting that thero is some organic change, however minute it may be, and, as yet un- discoverable, even in epilepsy proper, in chorea, in neuralgia, etc. There are two diametrically opposite kinds of functional changes. 1. Degrees from slight defect to loss of function. 2. Degrees from slight to excessive exaltation of function. The former, negative state of function, exists in cases of paralysis, the latter, positive (super-positive) state of function in cases of epilepsy, chorea, tetanus, etc. I never use the expression disorder of function, but speak of degrees of negative functional states, and of degrees of states of over-function. The two may co-exist. Some elements of the set of motor nervous arrangements representing a muscolar region may have lost function, whilst other elements of the same set may be in over-function. For example, we find not rarely persisting hemiplegia and occasional convulsion of the muscular region paralysed. One advantage of the scheme of investigation by the triple division is that we learn by it where our knowledge is deficient. Indeed, of some cases of nervous disease it would be commonly said that we know symptoms only. The scheme enables us to separate definitely what we know from what we only suppose. In chorea we know that there is the second kind of functional lesion; at any rate, it is an irresistible inference that the movements depend on unduly high instability of nerve cells.8 But we do not know the seat of that lesion, nor the pathological processes leading to it. On the anatomy and pathology of chorea all of us have hypotheses only, My speculation is that, ana- . / tomically, the lesion is of some convolutions of the/jtnotor area,/ A and that the pathology in most cases is plugging of arterioles. In illustration of the triple method I shall take a case in which our knowledge is fairly complete, an ordinary case of hemiplegia. Before I do this I will once more speak of types. As to range, I make two types of hemiplegia. In most cases the arm suffers more than the leg, in some the leg more than the arm. The division arm-type and leg-type is of practical importance. Were I obliged to be paralysed of the left side I should prefer the ordi- nary variety of hemiplegia, in which the arm suffers more than the leg, as I could do indifferently well without the use of the left arm, and could get about if the leg were only slightly paralysed. If the paralysis were to be of the right side, I would far rather that the leg suffered more than the arm, particularly because I should, the cerebral lesion being farther back, have little or no defect of speech. Taking for illustration the arm-type of hemiplegia, we may conveniently make three degrees of it. 1. Paralysis of the face, tongue, arm, and leg. 2. Greater paralysis of these parts, and also turning of the head and eyes from the side of the body paralysed. 3. Universal powerlessness (strictly not a degree of, but one beyond, hemiplegia). I pass over the third degree, as the situa- tion is too complex for illustration. I remark of the second that the additional symptoms, so to call them, betoken a grave lesion. I speak of the first degree only when illustrating the triple method of investigation. 8 There is, however, with the over-development of some movements loss of other movements of the same muscles ; the two opposite functional lesions, the Inference is, co-exist in chorea. In some'eases the paralysis (that is, loss of movements) preponderates (see Ciowers's Diseases of the Nervous System, vol. ii, p. 551, oil Paralytic Chorea.