Ophthalmology and diseases of the nervous system, being : the Bowman Lecture, delivered Friday, November 13th, 1885 / by J.Hughlings Jackson.

  • Jackson, J. Hughlings (John Hughlings), 1835-1911.
Date:
[1885?]
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Licence: Public Domain Mark

Credit: Ophthalmology and diseases of the nervous system, being : the Bowman Lecture, delivered Friday, November 13th, 1885 / 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.

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    hy the negative affection of consciousness, and, in some slighter degree, of more or less of the lower (more organised) centres. Westphal and Gowers have noted transitory absence of the knee-jerks after epileptic paroxysms, thus showing there to be sometimes exhaus- tion of lumbar nuclei, some lowest motor centres. Deep post-epileptic coma is psychically dementia, but is, on the physical side, nothing else than some universal, almost total, paralysis—paralysis not only of animal, but of organic parts also, proportionate to the degree of the prior epileptic discharge upon them.* This contention of mine is, however, denied; let us say, what cannot be denied, that the patient is nearly dead. I daresay my calling the psychical side of the condition insanity (dementia or amentia) will be objected to. Let us say that the patient is, or is nearly, mentally dead; this cannot bo denied. Moreover, the patient is suffering from asphyxia, from slow respiration, from imperfect circulation ; thus there will be a multiplication of effects. Possibly the asphyxia helps somewhat in re-evolution by strongly stimulating the respiratory and other partially exhausted (lowest) centres. There is one after-effect—a valuable eye-symptom— which is certainly paralytic,—transitory lateral deviation of the eyes, observed by Beevor instantly after severe attacks. Again, the exaggerated knee-jerks and foot- clonus after some fits (Beevor) imply paralysis, signify exhaustion of fibres in the lateral columns, and possibly also of inhibitory centres (Gowers) in the cord itself. Here we have after-effects at the two extremes—eyes (paralytic) and feet (implying some paralysis) ; it would be remarkable if the rest of the symptoms were not paralytic. I submit that it would not be possible for a neurologist to scientifically study this exceedingly complex disease without availing himself of the work done by different * Of course we cannot say that such super-positive phenomena as foot- clonus, passage of fasces, &c., after epileptic fits are paralytic, but they signify exhaustion of “ controlling ” nervous elements, are indirect evidences of paralysis.