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A Statistical Inquiry Into the Nature and Treatment of Epilepsy

      These three papers have already appeared in the Medical Journals, at different dates, during the past few years. They are now republished together, so as to form a connected inquiry. Since the production of the first and second of them, increased experience has greatly augmented the clinical material which might have been utilised in their investigation: but, as the essential facts have only thus been confirmed, and the general conclusions arrived at have remained the same, it has been thought best, with the exception of certain verbal alterations, to preserve the text of the articles as they originally appeared.

A. H. B.

      38, Queen Anne Street, W.

      May, 1884

      I.

      AN ENQUIRY INTO THE ETIOLOGY AND SYMPTOMATOLOGY OF EPILEPSY.1

      The science of medicine is to be advanced by the careful collection of well-recorded facts, rather than by general statements or unsupported assertions. No inquiry thus conducted with scientific precision can fail to be without value, and to add a mite to that store of positive knowledge from which must emanate all hopes of progress for the healing art. Our acquaintance with the nature of epilepsy is as yet in its infancy, and although much valuable practical information has been put on record regarding this disease, it is believed that the following contribution may not be useless in either confirming or questioning previous conclusions.

      The clinical aspects of epilepsy are especially difficult to investigate with exactitude. The physician, as a rule, is not himself a witness to the chief phenomena characteristic of the disease. He is therefore compelled, in most cases, to trust to the statements of the patient and his friends for their description, and even when the cross-examination is conducted with the greatest care, there are many points impossible to ascertain with certainty. In the following cases of epilepsy, which have been under my own care, those only are included in which loss of consciousness formed the chief feature of the attack; and in the succeeding particulars, attention will be specially directed to etiology and symptomatology.

ETIOLOGY

      This may conveniently be discussed under (1) Predisposing causes, and (2) Exciting causes.

1. – Predisposing Causes

      Sex and Sexual Conditions.– In one hundred unselected cases of epilepsy there were —

      showing that practically the sexes were affected in equal proportions. Of the females there were —

      The greater number amongst the unmarried females is probably due to the list including children, and also to the fact that epilepsy is not an attraction to a man who purposes matrimony. Of the married females —

      Thus, in the majority of cases, marriage seems to have no influence on the epileptic attacks of women, although in 27.2 per cent. the fits appear to have been diminished after that ceremony.

      Of the married females there were —

      Age.– In one hundred cases the age at which the first attack of epilepsy took place will be seen from the following tables: —

      It will thus be seen that, in males, the most prevalent period for the first invasion of epilepsy is from the tenth to the thirtieth year; in females, from the first to the twentieth year. In both sexes the disease rarely commences after forty. The following table shows the ages of the patients under observation: —

      This indicates that cases of epilepsy comparatively rarely come under observation after the age of forty. A large series of cases would however be required to determine any definite conclusions as to the mortality and longevity of the patients.

      Occupation and Profession.– These do not appear to have any special relation to the production of epilepsy.

      Hereditary Tendency.– In each of the cases under observation a very careful inquiry was made into the family history. This was confined to the parents, grand parents, uncles, aunts, brothers, sisters, and children of the patient. The following are the results: —

      No family history of epilepsy, insanity, nervous or other hereditary disorders in 59 per cent.

      One or more members of family affected with one or more of the above disorders in 41 per cent.

      Of these last, in which there was a tainted hereditary history, one or more members of the family suffered from —

      Concerning the above table, it is to be remarked that frequently the patient had several relatives suffering from different diseases; for example, one with epilepsy, a second with insanity, and so on. In such a case these have been classified under epilepsy, and, if this did not exist, under insanity, or other afflictions in the above order.

      Of those cases in which epilepsy was present in the family of the patient, it existed in the following members: —

      From these figures it will be seen that in no less than 41 per cent. of the total number of cases there was a distinct family history of hereditary disease. Of these no less than 87.5 per cent. were affections of the nervous system, and 12.1 per cent. of phthisis. Of the former 63.4 per cent. had relatives afflicted with epilepsy, and 12.1 per cent. with insanity. Epilepsy, according to these figures is eminently a hereditary disease, and it is possible even to a greater extent than is here represented; for the family history is often very difficult to arrive at, in the class of persons on whom most of these observations were made, who, either from ignorance or from prejudice, display a great want of knowledge concerning the health of their ancestors.

      General health prior to the first attack.– As far as could be ascertained this was —

      By the term delicate is understood any chronic derangement of health. The figures serve to indicate that, in the large majority of cases epilepsy has no necessary connection with the impaired general health of the patient.

      Special illnesses prior to the first attack.– There were —

      Of these persons who, prior to the first attack of epilepsy, had suffered from illnesses, the details are as follows: —

      The only special feature of this table is the fact that, of the cases of epilepsy under observation, convulsions at dentition were positively ascertained in 15 per cent. of the total number of cases, and in 43.7 per cent. of those having suffered from former illnesses. Here also the percentage is probably in reality greater, as it is obvious that many of the patients were ignorant as to whether or not these symptoms existed. There is no evidence that any of the other illnesses had any relation to the epilepsy.

      Temperance and Intemperance.– On this head nothing definite could be ascertained. The patients either do not tell the truth, or have very elastic notions as to moderation in the use of alcoholic stimuli.

2. – Exciting Causes

      To ascertain the exciting causes of epileptic seizures with exactitude is usually a matter of very great difficulty. It is simple enough when the results directly follow the cause; but this is not commonly the case. If, for example, a man, after a blow on the head (having been previously in good health) becomes suddenly seized with epileptic attacks within a few hours or days of the accident, we may fairly

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