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]
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.
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![chorea and migraine in the patient's blood relatives does not decide the question either way, because we have no certain knowledge of the pathology of these two morbid affections. The hypothesis I put forward as to the pathology of most cases of epilepsy (and for most cases of migraine and chorea too16) is that it is plugging of small cerebral arteries and its consequences. It is quite reasonable to consider first simpler cases of fits, epileptiform seizures, to see if their pathology countenances the hypothetical pathology I have submitted of epilepsy proper. I am not aware that anybody believes that the pathology in any case of epileptiform seizures is primarily nervous; that there is a nervous change (one of exaltation of function) is obvious enough, the occa- sional nervous discharges (liberations of energy) declare that there is. The nervous change is secondary, and is often determined by tumours and other masses; on this matter I have, in an earlier part of this address, said enough. But in some cases the (secondary) nervous state is a result of plugging of arteries ;17 in these cases the hyper-physiological or functional change, that of the nerve cells ( discharging lesion ) is in an arterio-cortical region, and is a very local one. The group of highly over-unstable cells making up the discharging lesion is certainly in but one side of the cerebrum, although sudden, etc., discharge of that lesion will, if the discharge be strong enough, produce universal convulsion. The conclusion is that in some cases of epileptiform seizures a local discharging lesion is a secondary result of abnormal nu- trition consequent on plugging of arterioles; in other words, that the pathology is exactly the same as that of most cases of hemi- plegia. The abnormal physiological state of nervous elements (the secondary nervous state) in the two is diametrically opposite; in the former case the change we are concerned with is a plus, in the latter a minus functional change, andis often actual destruction; in both cases the secondary—the nervous—state is persistent; in the former there are occasional excessive developments of move- ments (convulsions); in the latter there is permanent loss of movements. Why in the former case there is produced high insta- bility of cells (and no doubt destruction of many others) and in the latter destruction only, may possibly depend on differences in the degree of anastomosis of central and cortical branches of the middle cerebral artery; the former having none or next to none, the latter varying in that respect in different persons and in the same brain in different branches. Complete arrest of circulation in an arterio-cortical area would produce destruction of nervous elements; but some anastomosis might lead to a comparative 16 Dr. George Johnson, op. tit., p. 510, writes: Chorea is somet imes asso- ciated with, and apparently caused by, capillary embolism in some portions of the brain near the corpus striatum. 17 I have never believed that the local high instability of cells directly causa- tive of epileptiform seizures is produced by tumour only. I put forward the speculation that seizures of this kind (I then called them unilateral convul- sions) sometimes depend on embolism (London Hospital Reports, 1864, vol. i, / pp. 465-6), making the/ crude and, at that time, 1 In' following]much too-con- ( fident statement: They are, lam convinced, not Lmrequently the result of plugging of branches of the middle cerebral, partial occlusion of its main trunk or some of its branches. To the same effect: Med. Times and Gazette, August 13th, 1864, p. 167. I have re-stated the hypothesis I hope more clearly and correctly (St. Andrews Med. Grad. Trans., vol. iii, 1870; Reynold's System of Medicine, vol. ii, second edition, pp. 284-5). I have stated it with regard to both epileptiform seizures and epilepsy proper (West Hiding Asylum Reports, 1873, vol. iii, pp. 328 and 329; Med. Press and Circular, January 26th, 1876; Med. Times and Gazette. January. 1879.) Frank and Pit res (Archives de Physi- ologic, August 15th, 1883, No. 6) found that out of seventy-one cases of what I call epileptiform seizures, there were tumours in thirty-two cases, ramol- lisemeuts infiammatoires ou emboliques in sixteen; in the rest various other lesions.](https://iiif.wellcomecollection.org/image/b22303273_0031.jp2/full/800%2C/0/default.jpg)
