The Delusion of the Obvious

THE DELUSION OF THE OBVIOUS PAUL C. BUCY M.D.* It is a great honor and pleasure to have the opportunity to deliver the John Hughhngs Jackson Lecture here at the Montreal Neurological Institute . It is most fitting that this Institute, which has always been noted for its successful efforts at elucidating the structure and function ofthe human nervous system, should have chosen to honor Hughhngs Jackson in these annual lectures. Jackson was a remarkable figure in the field of medicine and even more remarkable in that he lived at the beginning ofmodern neurology in the second halfofthe nineteenth century. He is often referred to as the father of English neurology. Yet he differed greatly in his approach and his interests from the other outstanding figures in neurology in the nineteenth century—Romberg, Erb, Charcot, and Gowers—to mention only the more outstanding. These men, likeJackson, were plowing new fields. They, however, were more interested in the recognition and classification ofneurological diseases and in the description oftheir symptoms.Jackson, too, made contributions in this direction, but his primary interest and his great contribution to neurology were in using disease to understand the structure and function ofthe nervous system. He was one ofthe first and one of the most distinguished exponents of clinical investigation that neurology has ever seen. Jackson was interested in experiments performed on animals and recognized their value, but he was keenly aware that it is essential to study man ifhe would comprehend the human nervous system. He said, "The results * Northwestern University Medical School. From the section on Neurological Surgery, Chicago Wesley Memorial Hospital, Chicago, Illinois. Presented as the John Hughlings Jackson Memorial Lecture, Montreal Neurological Institute, May 5, 1965. These studies have beenaided by Grants Nos. B-1512 and NB-2745 and Training Grant No. NB-5408 from the National Institute of Neurological Diseases and Blindness ofthe U.S. Public Health Service, and by Project No. 17-115 from the Illinois State Psychiatric Training and Research Authority. 358 Paul C. Buey · Delusion ofthe Obvious Perspectives in Biology and Medicine · Spring 1966 ofthe now well-known experiments ofHitzig and Ferrier on the brains of lower animals are . . . infinitely more precise than any 'experiments of disease' are likely to be. . . . In whatever way their experiments may be interpreted, they are ofinestimable value for the furtherance ofClinical Medicine, Comparative Anatomy and Physiology. Nevertheless, the experiments ofdisease are the only ones we can observe in the case ofman." Anyone who has been a student at the National Hospital in Queen Square is aware that not only doesJackson's impressive bust adorn the entrance ofthat famed institution, but that his shadow lurks in every corner. It is not surprising that his peculiarities, of which there were a number, should be among the hallowed traditions ofthat hospital.Jackson's formal education was quite limited. It consisted ofwhat the grade school in his native village in Yorkshire and the small medical school in York, with ten or eleven students to a class, could offer, plus an additional year at St. Bartholomew's Hospital in London, where he prepared for his qualifying examinations before the Royal College of Surgeons and the Society of Apothecaries. Undoubtedly among the great influences onJackson were his associations with Dr. T. Laycock in York, who later became professor ofMedicine in Edinburgh, and SirJonathan Hutchinson in London. It has been generally assumed thatJackson's lack ofa more adequate formal education may account for the fact that he never handled the English language well and that his writings are often obscure. One can not help but wonder ifthis same lack offormal education may have accounted for his lack of respect for the printed page.Jackson had no qualms about tearing books to pieces—any books. "Penny dreadfuls" (comparable to some ofour modern "paper backs") or the most scientific treatises—were torn apart by him without hesitation. According to tradition at Queen Square, Jackson did not limit his destructive tendencies to printed books but extended them to hospital records as well. In keeping with his intellectual and scientific interests,Jackson did not find the interest in patients that other neurologists, such as Gowers, did. He did not like making "rounds" and particularly...