A rediscovery of Chevalier Jackson: Earlier historical descriptions of Barrett’s Oesophagus, its premalignant potential, and oesophageal adenocarcinomaA rediscovery of Chevalier Jackson: Earlier historical descriptions of Barrett’s Oesophagus, its premalignant potential, and of oesophageal adenocarcinomaSir,Foregut functions like breathing and swallowing are integrated across several anatomical regions. These regions have different types of sensorimotor supply. Controlling these functions depends on receiving and integrating information from the full path over which they are executed. Clinically however, converging sensory signals like between glossopharyngeal and vagus nerves in the pharynx, between the visceral and somatic vagal pathways at the pharyngo-oesophageal junction, and between multiple cranial nerves at the sensory trigeminal nucleus, degrades symptom localisation.A giant of Laryngology, Chevalier Jackson (1865-1958) intuitively understood the significance of poor symptom localisation in oesophageal cancer (Figure 1A). He also appreciated the vagueness with which early symptoms were described (Figure 1B) and studied the language patients with oesophageal cancer used to describe their earliest symptoms (Figure 1C-E). He argued against making ‘inferential diagnoses’ (Figure 1F). He created instruments and standardised surgical and anaesthetic techniques for examining the foregut and performed over 4,000 pharyngolaryngeal, oesophageal, and upper gastric examinations in awake patients (Figure 1G-H). 1From this clinical experience, Jackson made and published key observations. This included a series of 671 patients whose pathology included 337 and 316 cases of oesophageal squamous cell carcinoma and adenocarcinoma, respectively (Figure 1K).2 This predated Morson and Belcher’s case report description of oesophageal adenocarcinoma by almost 3 decades.3 It raises profound questions about current and prevailing views on the epidemiology of oesophageal cancer.Jackson also described a series of 88 patients with peptic ulcer4 and identified gastric mucosa within the oesophagus in a proportion of them (Figure 1J). Two decades later, this would be described again and would come to be known as Barrett’s oesophagus. 5 Jackson, for good measure, also identified the association between gastric-lined oesophagus and oesophageal cancer (Figure 1L).It is not difficult to imagine the impact Jackson’s work could have had on early diagnosis if it had continued, and on treatment if it had intersected with Sir Harold Hopkins’ work. He provides clues about why this did not happen (Figure 1M) and felt responsible for not insisting on competency standards for clinicians who took up his techniques. Today, with advanced diagnostic methods like Transnasal Panendoscopy and with treatments like Endoscopic Submucosal Dissection, opportunities have again arisen to make a difference to patient survival. It is an opportunity we can seize by working together (Figure 1N), by recognising early cancer symptoms, and by expeditiously diagnosing and treating early foregut cancers.