Kira in London -- Number Two

I am almost halfway through my week in London and I have had so many incredible interactions and discussions these past few days.  The rainy, gloomy climate in London is unfortunately paired with an equally foreboding political climate.  Brexit is ripe on everyone's minds, and in the city of London it has created quite a bubble of melancholy as the Londoners prepare for what they deem "the end of a respectable UK as we know it" on October 31st.   Last night at dinner, I sat with a few members of my host family (the father, Misha Glenny, is a British Journalist who specializes in Southeast Europe, global organized crime, and cybersecurity; the mother, Kirsty Lang, is also a British journalist and broadcaster for BBC Radio and Television--two brilliant minds who have given me a warm welcome in London and have taught me quite a bit about the political context of Brexit) and a scattering of other close family friends.  Over a scrumptious fish pie with green peas, we discussed the growing concern over the ultimate divergence of the UK from the EU.  As each person stressed how terrible Brexit and its effects will inevitably be, they mused ...'at this very juncture in time, who's worse off--Trump's America or Boris' Britain?'  All 6 sets of eyes turned to me and I tried my very best to raise their spirits about Brexit ... relatively speaking that is.  Although we came to no ultimate conclusion as to who was worse off, we had great conversations about what the ramifications for leaving the EU might look like--how the NHS will/won't hold up, and of course a few conspiracy theories here and there.

Today is Monday, August 12th 

Following the eventful, enjoyable and informative evening, I woke up charged and ready to go out and explore the archival world of London.  I set out for the British Library where I gained my Reader's Pass and explored the Science and Humanities reading rooms.  After finding a comfy seat in the back corner of the Science Reading Room, I perused the online collections and "requested access" to a few documents about John Hughlings Jackson.  Unfortunately, 2 of the documents I requested were not available for viewing, but the other 2 were ready after a short 30 minute wait.

The first document was one I had read online before, but was definitely a better reading experience on paper. It was Jackson's 'A study of Convulsions' published in Transactions in 1870 which was ultimately a dense text that laid necessary groundwork for cases of epilepsy. Jackson was able to describe the nature of focal epilepsy and the idea of localization as a result of the illness.  Jackson was a true trailblazer in that he was able to connect the dots between the body and the brain in the way that we know today.

The second piece I read was a manuscript of the lecture Hughlings Jackson gave at the London Hospital in June 1864--which was later published in the London Hospital Reports.  The lecture focused on a new and unique approach to medicine--especially in the field of neurology--which was a method of diagnostic neurology. The lasting impact of Jackson's lecture is still seen today in terms of the significance of clinical physiology. 

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Today is Tuesday August 13th, and it is my first day in the Queen Square Library at UCL.  A few weeks ago I had sent an email to one of the librarians asking about any archives she might have on John Huhglings Jackson. I received a prompt reply ultimately saying that yes, indeed, there were a few Case Books of Dr. Jackson that I could peek into as well as a letter of correspondence between Dr. Jackson and the secretary and general director at the hospital.

Time flew as I sat at the specially demarcated "archival desk" near the librarians and skimmed through the two 100+ page Case Books of Dr. Jackson that had been set out for me.  The books themselves were large and intimidating-- 14in x 12 in x 5in --with gold embossed print (pictured below). Lifting the heavy cover made me wonder about the convenience of such a book in terms of carrying it from patient's room to patient's room.  But once I began reading Jackson's notes I began to figure out why such a large book was necessary.  Every case was important to Jackson.  His notes per patient ranged from 10 to 15 pages and were incredibly detailed.  And although his cursive handwriting was difficult to decipher at times, it was much easier to digest than his published work!  Indeed, every case required an in-depth study of the patient's life and wellness up to the date of admission and an incredibly detailed description of the illness itself.

The cover of Dr. Hughlings Jackson's 1888 Case Book

A quick look into what I found in these Case Books: 

May 4^th, 1888--This patient was a 54 year old man who suffered from bowel inflammation “with pain like a red hot iron” twenty years prior to his date of admission.  According to Jackson, he suffered a stroke which resulted in loss of lower motor functions and power over bladder.  Ultimately he was diagnosed with left hemiplegia.  Over the 6 months that he was in the hospital, Jackson took great care in detailing the patient's improvements and declines.  He wrote about 11 pages of notes for this patient and on the last page he had the patient date the page and sign his name (picture) to illustrate the loss of his motor functions.  

The first seven or so patients suffered from hemiplegia, so I decided it would be a good idea to research the disorder and learn a little more about what it is.  I learned that hemiplegia is a neurological condition that affects everyone differently but essentially results in varying degrees of weakness and a lack of control--generally on one side of the body.  Epilepsy is also very common in people with hemiplegia. The definition of the word hemiplegia (sometimes called hemiparesis) means paralysis of half of the body.

"Both hemiplegia and epilepsy are conditions caused by a malformation or damage to the brain or a change in the way the brain works. In some people the brain damage that causes hemiplegia can also cause epilepsy. Statistics vary, but at least 20% (one in five) of children with hemiplegia also have epilepsy. In most children with both conditions, epilepsy starts before the age of five and the chances of developing epilepsy seem to reduce as the child gets older, especially after the age of 10." (https://www.epilepsysociety.org.uk/what-hemiplegia) 

Another case in the book was about a man named John Thomas Doddington (Age 36) who had epilepsy and had paralyzed his vocal cord in one of his ‘fits.’ In the clinical notes, Jackson included a chart that listed the days on which seizures occurred and the degree (severe of slight) of the severity.  

An example of what the first page for each patient looked like

Medical chart for seizures ('fits')

Interestingly, there was a case about a man who had seizures and for his treatment he underwent trephination. This was all new to me since I had never read anything about the surgical treatments that Hughlings Jackson performed.  

Overall observations:  Jackson’s notes on his patients are very impressive in their content and level of careful observation.  Every patient received his full attention and ultimately ~10 pages of clinical notes were written in total during the patients' stays.  He also references vision quite a bit in his case notes which I found interesting because the connection between eyesight and diseases of the brain was not yet made clear during the mid 19th century. Regardless, Jackson somehow knew that keeping track of vision was paramount to understanding some neurological diseases. 

Below are a few more pictures that I took that I found to be very interesting. 

This was a file that contained a range of documents relating to Hughlings Jackson (i.e. a copy of the lecture in 1864 that he gave, his obituary, and more)

Here is a picture of the hand of one of Hughlings Jackson's patients.  I'm still not certain what he was trying to imply with the ridges on the last two finger nails... 

A brief timeline of Hughlings Jackson's life 

Illustrates how doctors during the Victorian Era tracked vital signs. The jagged line is the body temperature

This was Jackson's way of gathering information about vision and eye health

This was at the back of the clinical notes and I thought it was fascinating how organized Jackson was with all his data and patients information

Indeed, my adventure to the Queen Square Library was a success and I could not have done it without the stupendous Librarian Sarah Lawson! Thanks to this visit I feel much more fluent in the lingo of 19th century Neurology and medicine.  Now I have a much clearer view into what Dr. Hughlings Jackson's average day might've looked like and I am all the more fascinated!  Without this research opportunity these discoveries would not have been possible and thus I am so so grateful for this rich, surprising, and gratifying experience. Onto the Wellcome Museum I go!