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[约翰·胡克林·杰克逊医生]

[Dr. John Hughlings Jackson].

作者信息

Janković S M, Sokić D V, Lević Z, Susić V

机构信息

Institute of neurologu, Clinical Centre of Serbia, Belgrade.

出版信息

Srp Arh Celok Lek. 1997 Nov-Dec;125(11-12):381-6.

PMID:9480576
Abstract

The great English neurologist, Dr. John Hughlings Jackson was born in Providence Green, Yorkshire, north England, in 1835. He spent his apprenticeship in the city of York, continued his medical education at St. Bartholomew's hospital in London, and qualified in medicine in 1856. After working in the city of York, he studied in London and in 1860 graduated at St. Andrews university in Scotland. He died in London in 1911, famous and celebrated by his colleagues as the "father of British neurology". Jackson was a prolific writer, witty and ingenious person, but also solitary and absent minded, with a lat of "tiny peculiarities of a genius". At first he was committed to become a philosopher but was persuaded by Jonathan Hutchinson, one of his rare friends, to enter medicine. His "Selected Writings" were first published in 1931 and reprinted recently, in 1996, by Arts & Boeve. Jackson, unlike William Richard Gowers, wrote his articles in a style which was not palatable to his contemporary colleagues. This could be the reason that his medical work was not widely known and would have remained in shadow had it not been rediscovered mostly by German neurologists, who preceded their English colleagues and collected the fame. Jackson gave the first classification of epileptic seizures acceptable, to a degree, even today. It was twofold: the first, taxonomic, which corresponds to contemporary classification of seizures, he compared to the attitude of a gardener who classifies flowers according to their beauty, height or color, and was aware of its purely phenotypic, descriptive and utilitarian character; the second was scientific, physiologic and it would correspond nowadays to the current concept of syndromic classification. Jackson was aware that this 'scientific classification' was to await for the future time, when the knowledge of the real nature of epilepsy became fundamentally broadened. On the other hand, he thought that all the epilepsies were partial becoming generalized only secondarily. Partial epilepsies were the starting point in his work. He realized that epileptic attacks are not different types of epilepsies with different pathophysiological mechanisms, but that they differ in respect to the focus of origin; he stressed their gray matter (cortical) arigin with the cause located as the rule "on the side of the brain, opposite to the body convulsed". Jackson's ideas on epileptogenesis and the localization of epileptogenic processes represent his fundamental contribution to the understanding of their pathophysiology. His most philosophical contribution to neurology was the concept of the evolution and dissolution of the nervous system, which was the consequence of his ideas on its organization. Symptoms observed after the lesion of a certain part of the brain are not the consequence of its function; they are the result of the function of the remaining non-lesioned regions which are in a certain way freed from the adjacent or a higher control. This concept of interpretation af the symptoms of the nervous diseases remains applicable even today. Jackson was the first to stress the importance of ophthalmoscopy in neurology in all cases of neurologic disease, especially in cases of optic neuritis (papilloedema) which may be present even if the patient did not notice the minimized visual acuity. The way of thinking that Jackson introduced in medicine and neurology may be his most precious legacy to the generations that followed.

摘要

伟大的英国神经学家约翰·休林斯·杰克逊博士于1835年出生在英格兰北部约克郡的普罗维登斯格林。他在约克市当学徒,之后在伦敦的圣巴塞洛缪医院继续接受医学教育,并于1856年获得医学资格。在约克市工作后,他前往伦敦学习,并于1860年毕业于苏格兰的圣安德鲁斯大学。他于1911年在伦敦去世,被同事们誉为“英国神经学之父”,声名远扬。杰克逊是一位多产的作家,机智且富有创造力,但同时也性格孤僻、心不在焉,有着许多“天才的小癖好”。起初,他立志成为一名哲学家,但在他为数不多的朋友之一乔纳森·哈钦森的劝说下,转而投身医学。他的《文选》于1931年首次出版,最近在1996年由艺术与博埃夫出版社再版。与威廉·理查德·高尔斯不同,杰克逊撰写文章的风格不为他同时代的同事所接受。这可能就是他的医学著作未广为人知的原因,若不是主要被德国神经学家重新发现,他的著作可能会一直默默无闻,而德国神经学家先于英国同行并收获了声誉。杰克逊给出了癫痫发作的首个在一定程度上即使在今天也可接受的分类。该分类有两重:其一为分类学分类,这与当代对发作的分类相对应,他将其比作园丁根据花朵的美丽、高度或颜色对花朵进行分类,并且他意识到这种分类纯粹是表型的、描述性的和实用性的;其二是科学的、生理学的分类,如今它对应于当前的综合征分类概念。杰克逊意识到这种“科学分类”有待未来,那时对癫痫真正本质的认识将从根本上得到拓宽。另一方面,他认为所有癫痫起初都是局部性的,只是后来才继发全身性发作。局部性癫痫是他研究工作的起点。他认识到癫痫发作并非具有不同病理生理机制的不同类型的癫痫,而是它们在起源部位上存在差异;他强调癫痫发作起源于灰质(皮质),其病因通常位于“大脑中与抽搐身体相对的一侧”。杰克逊关于癫痫发生及致痫过程定位的观点是他对理解癫痫病理生理学的根本贡献。他对神经学最具哲学性的贡献是神经系统进化与解体的概念,这是他关于神经系统组织观点的结果。大脑某一部位受损后观察到的症状并非该部位功能丧失的结果;它们是其余未受损区域功能的结果,这些区域在某种程度上摆脱了相邻或更高层级的控制。这种对神经疾病症状的解释概念即便在今天仍然适用。杰克逊是第一个强调在所有神经疾病病例中,尤其是在视神经炎(视乳头水肿)病例中眼底镜检查重要性的人,即使患者未察觉到视力轻微下降,视乳头水肿也可能存在。杰克逊在医学和神经学领域引入的思维方式可能是他留给后世的最宝贵遗产。

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