“If it continues…without alleviation, there is ground to anticipate some more grave disease of the brain.” So wrote James Jackson, MD, regarding patients with headache. His words seem antique and indeed they are, published in 1853 in his book Letters to a Young Physician Just Entering Upon Practice.
James Jackson was perhaps the leading doctor in early 19th century Massachusetts. Born in 1777, he became professor of medicine at Harvard Medical School at the age of 35. Together with John Collins Warren he was instrumental in the founding of the Massachusetts General Hospital. Jackson was a prolific writer, including publication in the New England Journal of Medicine. In 1836 he published a memoir of his son who had died at the age of 25, on the verge of beginning his own career as a physician. Jackson himself died in 1867 at the age of 90.
While his specific medical recommendations regarding the management of headache, epilepsy, apoplexy, etc. scarcely apply today, much of Dr. Jackson’s advice speaks to us still. He exhorts his “young physician” reader to strive “for the common good. A desire for profit and reputation might be enough to prompt him to do all this; it would also be good policy. But he will not do it with a full certainty of success if he be not influenced by still higher motives: by a true love of science and humanity.”
Jackson does not insist on saintliness from his physician readers: “We are justified in looking for profit and honor…only we must not be thinking of these when at the bedside. There the welfare of the sick must occupy us entirely… The patient is the central object in the sick-room, or should be so.” (Surgeons might add the OR as well). And as if addressing those who insist that doctors’ fees are the ruination of our healthcare system, consider that “it is for the public good that [medicine] should hold out due rewards, so as to attract to it young men of talents and sound learning.”
The science of medicine and neurosurgery continues to evolve. We can be sure that in another 150 years most if not all of our current practice will seem as quaint as that of James Jackson appears today. But we can be equally sure that the art of medicine he urged on his readers will remain forever timely.
Michael Schulder, MD, is vice chair of the Department of Neurosurgery and director of the Harvey Cushing Brain Tumor Institute at the North Shore Long Island Jewish Health System, Manhasset, N.Y.