Brain, Vol. 122, No. 6, 1199-1200,
June 1999
© 1999 Oxford University Press
Book Reviews |
JOHN HUGHLINGS JACKSON—FATHER OF ENGLISH NEUROLOGY.
.
University of Wales College of Medicine, Cardiff, UK
Biographies are written and read for many reasons. They can provide a study and analysis of the subject's environment, work and achievements, they can delve into the subject's personality and how that may have contributed to their achievements and they can document the subject's formative experiences. As well as the objective documentation of a life, the writer can give their own perspective on that individual. The reader can learn from the life of the subject and can draw caution or inspiration. Macdonald and Eileen Critchley have taken on and largely succeeded in the task of chronicling the life and work of the pre-eminent neurologist of his generation, one of the four founders of this journal. Perhaps their strongest motive in writing this book is given by Macdonald Critchley in his preface when he notes that `some readers in these modern times may not find it easy to understand the sheer love my teachers had for their colleague . . . I am fortunate to have experienced it at second hand', a comment that perhaps reflects not only upon Jackson but also upon modern times. This recording of the life of Jackson goes a considerable way to explaining that love and why he was held in such high esteem. This book is not only a record of the man; the history of neurology itself might, to borrow from Thomas Carlyle, be considered to be the biography of the great neurologists, and this book also serves to explain the impact that the philosophical, imaginative and perceptive thinking of Hughlings Jackson had on the speciality itself in its earliest days. We are, incidentally, reminded of the youth of the speciality by one of the authors' own links with Hughlings Jackson. Macdonald Critchley attended a dinner held in 1935 to commemorate the life and work of Jackson, presided over by Kinnear Wilson, who had arrived at the Institute of Neurology in 1904 when Jackson was 70 and still practising.
The first chapters give the details of Jackson's ancestry and early life (and in deference to my current employer it must be pointed out that the father of English neurology was in fact half Welsh). These pages are exhaustively researched, predominantly by Eileen Critchley, and are likely to prove definitive. In addition to the tracing of public records and tombstones there are anecdotes that could only have been provided by Macdonald Critchley's lifetime in neurology. I particularly liked the description of an early treatment of epilepsy, requiring the use of a cockerel, a pin, a Poor Box and the Lord's prayer. If only it were so easy now. There is some disappointment, one suspects as much for the biographers as for the reader, in the dearth of information available about his childhood and formative years. It should be remembered that Jackson was not a public figure, the significance of his work was only appreciated after his death, he produced no offspring and, to confound those who might attempt to write his biography, his Will contained instruction to `destroy all my letters and diaries and all my case books and all correspondence relating thereto'. From the remaining evidence then it is hard for the amateur psychologist to glean the source of his personality, drive and inspiration. There are one or two clues. A letter from his father, written after Jackson had begun medical school, gives 12 000 words of warning against various forms of turpitude then adds, as a prolonged postscript, another 150 words of moral aphorism. One can imagine that only the greatest success might please his father, although to be fair to him he did add that, whilst he expected Jackson to win the race, `a good second is no disgrace'. His training and apprenticeship to a general practitioner was similar to other students of his era and it was only on coming to London, and the Critchleys suggest, the influence of Brown-Sequard, that he began to study the brain.
In the next group of chapters his published work, on epilepsy, speech and the cerebellum is considered. His method of prolonged clinical observation, careful description and then hypothesis on mechanism is described and discussed. Differences of opinion with colleagues, couched in the most polite language, are considered. These chapters allow the uninitiated to grasp the basics of Jackson's ideas, and their impact on the understanding of neurological function both then and now. It is also appreciated and emphasized that the starting point for his observation and description was his enormous clinical expertise and fascination with the subject.
The biography then considers other neurologists' comments on his work, before piecing together quotations and snippets of information giving insight into his nature. For me, these are the best chapters in the book. We can guess from the preface `In my 97 years I have never known any neurologist to arouse such deep affection' that it is not going to be the most critical judgment, yet the Critchleys justify this appreciation with pages of quotation about his manner, the influence of his personality on others and his extraordinary generosity and modesty in scientific ideas. It is not entirely uncritical. We read that he may have been only a modestly talented teacher and was astonishingly absent-minded (on one occasion pulling out a handkerchief and dropping a piece of brain tissue on the table). He may not have been the most communicative of physicians and perhaps not the bravest. It was said that `He would take some pains to avoid passing the bed of a patient he was powerless to help' and `he disliked insanity and seemed to have a real dread of such patients'. Yet the overwhelming sense is of a studious, sensitive and dedicated clinician with massively high standards of personal conduct and morality. The daughter of a close friend gives another insight into the great man, away from the idolatry of his neurological colleagues. She recalls him as a lonely man (after the loss of his wife) taking her to town in his landau, and sitting quietly with a thoughtful and rather wistful expression. Her affection for him simply as a human being, outside of his profession, pours from the page. Perhaps as a comment on the nature of such things we are reminded by the Critchleys that, despite his great achievements, and maybe as a consequence of his personality, he was never made a professor nor did he receive state honours.
It is tempting to speculate on how Jackson would have fared in the English neurology of today. We know that he used, to quote F. M. R. Walshe, neither apptus nor animal experiment, but that his contributions came through `the application of a scientific imagination to the material of his observations'. So, no research degree and no skills in basic science. We know that, again quoting Walshe, `in general he was an untidy writer'. His habit of appending footnotes to clarify obscure passages would surely not be tolerated by today's self-important editors and reviewers and so his list of publications might be a little thin. He does not appear (perhaps through his Yorkshire half) to have been blessed with the excellent communication skills deemed desirable in clinical practice today; it is commented, for example, that he was known for `giving opinions to patients which were not sufficiently hopeful or confident'. Worse still for his chosen career, it was said that `there are few who have ever seen him at a public dinner or on a platform' and, as perhaps the final nail in the coffin, it appears that he never travelled abroad `if he could help it'. Sorry Dr Jackson, perhaps you might consider another occupation.
Aside from fulfilling its aim in recording his life and achievements this book is very entertaining. There are some wonderful quotations that read well today. Modern educationalists have only recently embraced the idea that `too early education, especially if rigidly kept to a few things, is narrowing and tends to hinder the higher development of mind . . . not the least valuable part of a man's culture is from that which he picks up for himself' and `overeducation of the young has produced the mediocrity of intellect of the present day'. His comments on humour remain apposite: `The man who has no sense of humour . . . has not the surplus intellect which sense of humour implies' and people who `are deficient in appreciation of jokosities' are `in corresponding degrees deficiently realistic in their scientific conceptions'.
To my surprise (after all, there is surely only one thing more dry than a neurologist writing about a neurologist, and that is a neurologist writing about a neurologist writing about a neurologist) I thoroughly enjoyed this book and would not hesitate to recommend it both to the novice Jacksonologist and to the expert looking to fill in the gaps in his or her knowledge. If, however, you are in search of that professorship or knighthood, it might be better to look elsewhere for inspiration.
The Guarantors of Brain have a number of copies of this book, John Hughlings Jackson—Father of English Neurology by Macdonald Critchley and Eileen Critchley, which are available to subscribers at the discount price of £23.70 plus postage. Please contact the Brain Editorial Office to make your order. Cheques should be made payable to The Guarantors of Brain.
Notes
By Macdonald Critchley and Eileen Critchley.
1998. Pp. 224. Oxford: Oxford University Press.
Price £39.50. ISBN 0-19-512339-5. 
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