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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    the highest centre. Ferrier and Gerald Yeo find, by experiments—ablations—on monkeys, that movements of the eyes and head are represented in the frontal lobes. There is another important eye-symptom in epilepsy : apparent alteration in the size and distance of objects. It occurs, I think, most often in those epileptic attacks in which there is the “ dreamy ” state. It is physically a “motor affairthat size and shape are not simply “ retinal affairs ” is easily proven. Here we avail our- selves of the definite knowledge of the ophthalmic surgeon (the micropia after instillation of atropine; in paralysis of an internal rectus; the opposite condition after eserine). But we must not apply the knowledge derived from such simple cases to alterations in size of external objects at the onset of epileptic fits without great caution, the situa- tion being an exceedingly complicated one. I have already stated an hypothesis regarding the mode of pro- duction of these phenomena. Dr. Gowers has considered them with his usual ability in his valuable work ‘ Epilepsy,’ p. 64—a work rich in ophthalmological knoAvledge. Although I have spoken of epilepsy, there are really very many epilepsies, and thus, illustrating by the eye- symptoms (vertigo, colour, alterations in size or distance of objects), we should try to find the particular sequence of symptoms of other kinds, of which each of the eye- symptoms is the prelude. Epilepsy is not a complex thing when it is empirically regarded as a clinical entity, which for some purposes it should be. It is comparatively easy to note the “ causes,’’ “ warnings,” &c., “ of epilepsy ; ” much good work has been done in that way. But, besides investigating in this way, we have to “ turn ourselves round” and try to ascertain what different symptoms result from differently seated “ discharging lesions ” of the highest centres. We have the large compound ques- tion to answer. What is the constitution of the “ organ of mind” (highest centres) by which it results (1) that discharges beginning in different parts of it produce different epilepsies,—produce, if severe wuough, nearly