The Bowman Lecture on Ophthalmology and Diseases of the Nervous System
Authors: J. H. Jackson
Journal: BMJ (1885)

least, to be able to suspect hypermetropia as a cause of head-troubles, THE BOWMAN LECTURE but only the skilled ophthalmic surgeon can estimate it precisely, and correct it accurately.OK I think we often err by undcrating the c'mplexity of so'o nervous OPHTHALMOLOGY AND DISEASES OF diseases.I take epileptic paroxysms and their after-conditions as being, together, an illustration of the morbid nervous affection of THE NERVOUS SYSTEM.greatest complexity of symptoms.When its symptomatology is fully displayed, it shows, I submit, the imperative necessity of (1) different, WDctrered efOlrC the Otphthanlological "'oietF, l'cic, 2Nor lu, tber 1l.(2) definite, (3) wide knowledge, and of (4) co-operative work.I speak By J. HUGHLINGS JACKSON, M.D., F.R.S., of the "genuine epilepsy" of nosologists," not of epileptiform seizures.physician to the Loudon Hospital, and to the Hospital for Epilepsy and Paralysie.Epilepsy is a disease of the " organ of mind"-that is to say, of the highest and most complex, etc., centres.The syimptomatology of BESIDES acknowledging the honour of being asked to deliver an ad. the paroxysm is probably an universal synmptonmatology, is dentondress before this Society, I wish to say that I consider it an additional sta y nearly so.It may b said that inanity is uore complex gratifica that the address is the "Bowman Lecture."Praise than epilepsy ; not so, since epileptic paroxysms are not unfrequently gratification that the address is the "Bowma n Lecture."Praise followed by temporary insanity.The study of epilepsy, therefore, in- from me to Bowman would be impertinence.But here is my oppor-volves the study of some cases of insanity.These insanities are what tunity, not only for thanking Sir William Bowman for the benefit I have called the after-conditions of the epileptic paroxysms.We which I, like the rest of my profession, have derived from the basic ought, of course, to speak of epilepsies as we should do of insanities; work he has done, but of also tendering him my warmest personal for certainly, if two epileptics have different "warnings" of their thanks; for much encouragement given me in tle work I was, many fits, the discharging lesions" arc in different parts of the highest centres in the two cases.There are many epilepsies, and many in- years ago, trying to do.At the samo time, I gratefully acknowledge sanities.But now I give e¢ bloc the symptoms of many severe epi- that to his successor in the presidential chair (Mr. Hutchiiison) I feel leptic fits, of many slight lits, and the symptoms of epileptic fits (or, I highly indebted for my earliest instruction in ophthalmology, as well should say, epileptiform seizures), artificially produced in dogs; all r a s for great help of very many kinds for many years.are, at any rate, symptoms produced by cortical discharges.Among aforgreathelp of yman kindfor anthem are very important eye.symptoms.It was long ago said that division of labour, or, more generally, At the climax of a severe fit we see the allebraical sums of the co differentiation, is an universal law.Things become increasingly operations and antagonisms of strongly developed movements of all numerous and more different, or, in other words, more complex.Dif-the muscles of animal life accessible to observation-universal con- ferentiation is well seen in the development of animal organisms, and vulsion.As to wide involvement of sensory elements in the epiis seen, too, in the social organism.It would be very remarkable if leptic discharge, we can say that this is implied by "warnings" of there were an exception in the case of one part of tho social organism, crude and excessive smells, colours, sounds, tastes, by tinglings, etc., tie body medical-if in so great a field of work as the medical there of the hands, and by many crude and excessive systemic sensations.did not arise more and more different workers in different parts of Of what happens in the sensory sphere after loss of consciousness, we that field.There is no exception.The body medical is now very can say nothing.Besides colour-development, there is another eye- complex ; there are alienist physicians, obstetric physicians, neurolo-symptom-a vertigo-in which external objects seem to move, implygists, ophthalmic surgeons, aural surgeons, dentists, physiologists, ing discharge, direct or indirect, of motor cerebral elements represent- chemists, etc.; the speciality of each comes out of, is a difrfrentiated ing ocular movements.We find dilatation of the pupils, perhaps, part of, a wide general knowledge.sometimes contraction; there are great pallor of the face, increased Specialists have to justify themselves-to justify their differentiation.flow of saliva, perspiration, alterations of pulse and respiration, Differentiation is not the whole of the modern doctrine of evolution.passage of urine and fieces, and erection of the penis.The factors in progressing evolution, according to Spencer, are Vulpian curarised a dog, thus putting the muscles of animal life increasing (1) differentiation, increasing (2) definiteness, increasing out of the reach of an artificially induced discharge of the dog's left (3) integration, and increasing (4) co-operation.1 sigmoid gyrus (artificial respiration).Speaking almost only of effects Increasing differentiation without increasing definiteness would be of cortical discharges, which I have not yet mentioned, there were only confusion.That the ophthalmic surgeon has justified himself in slowing and irregularity of the heart, raised arterial pressure, in- the second factor of evolution needs no proof.I will instance, how-creased flow of bile, a little paling of the kidneys, and diminution of ever, his highly definite work on paralyses of ocular muscles and on their secretion, contraction of the bladder, and contraction of the abnormalities of refraction.In neurology, I may instance the work of spleen.Charcot.And here I must say, as the examples are intended to So we go a long way towards showing that the epileptic paroxysm imply, that by definiteness I mean definiteness which connotes has an universal symptomatology, having shown that sensations are exactness.