Hughlings Jackson on psychiatry

involving the rise of the health centre and the health care team. In terms of precursors, these ideas went back at least to 1920; in terms of operational application, the modernization of general practice cannot really be said to have begun before 1966. It may even be argued that the characterization of modern general practice-"a network of surveillance that discovered, identified and monitored the common disease, the minor symptom, the transient illness which hardly marked the body of the patient" (p. 84)-is little more than a gleam in the eye of a few luminaries in the Royal College of General Practitioners, rather than an epistemological reality representative of the body of general practice. As far as this aspect of medicine at least is concerned , the Dispensary might lie in the future, but it is not standard for 1948, nor even for 1984. Formidable obstacles confront anyone trying to come to grips with the thought of John Hughlings Jackson. Despite the urging of his friends and colleagues, Jackson never collected his contributions into a single magnum opus; as a result, his writings remain scattered in numerous articles, some of which are to be found in rare and obscure journals. Only partial collections of these papers exist. To add to the problem, Jackson's prose is dense and, at times, opaque. These facts go far to explain why, for all his importance to clinical and theoretical neurology, Jackson remains elusive to the historian. We are therefore indebted to Dr Dewhurst for having undertaken the onerous task of sifting Jackson's diffuse and turgid works to produce a concise and lucid summary of his ideas on psychiatry. Jackson emerges as a complex and subtle thinker-as, in J. J. Putnam's words, "one of the great philosophers of medicine". For the scattered character of Jackson's output masks the inner coherence of his analysis of apparently disparate topics and a formidable determination to achieve a unified understanding of all diseases of the nervous system. Psychiatric disorders were seen as merely one form of nervous disease. Jackson was perhaps the most single-minded and uncompromising of psychiatric physicalists: "if there be such a thing as a disease of the mind", he held, "we can do nothing for it." He was unwilling even to consider the existence of such an entity as a "psychological malady", regarding hysteria, for example, as a form of malingering. Jackson approached psychoses with an essentially …