Abstract
This chapter aims at briefly presenting the specific historical context of epilepsy’s emergence as a neurological disorder, during the second half of the nineteenth century. It begins with a short introduction into the political, social and economic conditions that dominated in nineteenth-century English society, in order to illustrate the impact of the Industrial Revolution upon people’s lives and to highlight the significance of medicine’s consolidation as a distinct scientific field during that period, when healthy and docile bodies were absolutely necessary for the substructure of the capitalist building. From this perspective, it describes next the epistemological, as we could call it, level of these significant transformations. In other words, the chapter focuses on scientific medicine’s emergence, at the end of the eighteenth and the beginning of the nineteenth centuries, and its course in Victorian society, in order to delineate its major characteristics by the time neurology was born. Taking all this into consideration, the chapter closes with an effort to depict epilepsy’s and epileptics’ course from classical Antiquity until the second half of the nineteenth century, when the National Hospital for the Paralysed and Epileptic opened its gates.
The modern bourgeois society that has sprouted from the
ruins of feudal society has not done away with class antago-
nisms. It has but established new classes, new conditions of
oppression, new forms of struggle in place of the old ones.
K. Marx & F. Engels, Manifesto of the Communist Party
Our thesis is that the idea of self-adjusting market implied a stark
utopia. Such an institution could not exist for any length of time
without annihilating the human and natural substance of society;
it would have physically destroyed man and transformed his
surroundings into a wilderness.
K. Polanyi, The Great Transformation: the political and economic origins of our time
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Notes
- 1.
According to contemporary medical criteria, he was suffering, in all probability, from temporal lobe epilepsy.
- 2.
The pressure of public opinion proved unbearable for Dostoyevsky, especially, after the death of his three-year-old son Alyosha, in May 1878, from convulsions, which were, rightly or wrongly, diagnosed as epilepsy.
- 3.
The novel was first published in serial form in Dickens’ weekly magazine Household Words (April–August 1854).
- 4.
A rather illustrative example has been George Orwell’s criticism that “[t]here is not a line in the book that can properly be called Socialistic; indeed, its tendency if anything is pro-capitalist, because its whole moral is that capitalists ought to be kind, not that workers ought to be rebellious”, and his simultaneous admittance that the writer revealed “a man who is generously angry” (Orwell 1940).
- 5.
We should keep in mind that the 1832 ‘Reform Act’ and the modification of the 1834 ‘Poor Law Act’ signified, in a way, the beginning of modern capitalism, as they put an end to the system of benefits, which was still in use after the recent initiative of Speenhamland, in 1795. We should note that the law of Speenhamland had provided additional benefits to wages, in correspondence to the price of bread. So, contrary to the Elizabethan Poor Law that had provided benefits only to those who could not find any regular employment, Speenhamland provided benefits even to those who did have a regular employment. According to Karl Polanyi, Speenhamland had been, to a great extent, a protective initiative of the upper social classes, within the frame of the agricultural communities, in order to prevent the imminent danger from the rise of urban wages. However, Speenhamland did, in reality, lead to further penury and poverty of a high percentage of the English population. Its recall, in 1834, had been an initiative of the rising middle classes (Polanyi 2001).
- 6.
According to Carlo Cipolla, “[y]et the Industrial Revolution was only the final phase, the coherent outcome of a historical development which took place in Europe over the first seven centuries of our now expiring millennium” (Cipolla 1993: xi). In fact, even, until the 1780s, the majority of the English products, equipments and workplaces presented many similarities to their counterparts not only at the beginning of the eighteenth, but even at the beginning of the seventeenth centuries. It was only after 1770, that some industries – at first, a few, but, continuously multiplying – were developing and modernizing at a faster pace, proceeding to the introduction of entirely new machines on a larger scale.
- 7.
With the term “market economy”, we mean a self-regulating market that, according to its theorists, had the possibility to organise every aspect of economic life without the need of any kind of protectionism or state interventionism (Polanyi 2001).
- 8.
In 1851, city residents constituted, for the first time, 51 % of Britain’s total population, while London inhabitants reached 2,500,000. Accordingly, during the period 1800–1850, the British population had been almost doubled.
- 9.
The construction of an expanding heavy industry and the so-called “Railway Mania” – especially, during the years 1835–1837 and 1844–1847 – literally transformed the communication sector inside Britain, while steam vessels and the construction of a whole series of channels facilitated Britain’s communication with other European countries. It is indicative that, already in 1822, steam vessels connected Britain with France and reached the Danube.
- 10.
In 1833, 1,500,000 people were directly employed in, or were dependent on, cotton industry.
- 11.
The term “middle class” appeared, for the first time, in 1745. It is characteristic that in 1851, there were in Britain, among other things, 16,000 lawyers, 17,000 doctors and surgeons, 3,000 architects, 1,300 “editors and writers”, etc. (Hobsbawm 1996).
- 12.
This was especially reinforced by the 1832 ‘Reform Act’ that denied the voting right to those belonging to the working classes, as well as by the reformation of the ‘Poor Law’ that denied them the right to any kind of benefits.
- 13.
We should keep in mind that, in early modern Europe, strikes constituted a common means of workers’ resistance that dated back, at least, in the mid-thirteenth century. Quite often, these reactions had the form of the so-called “walkout”; that is, workers left their tools and abandoned not only their workplace, but also their town, to return only when their demands were satisfied by their employers or by the local government. Moreover, several protests and demands of the working population were focusing on other issues, as well; during the sixteenth century, there were, most commonly, religious issues, as it was the German Peasant War, during the years 1524–1525 (Duplessis 1997; Scribner and Benecke 1979; Engels 1926).
- 14.
According to Polanyi, “[t]he true criticism of market society is not that it was based on economics – in a sense, every and any society must be based on it – but that its economy was based on self-interest” (Polanyi 2001: 257).
- 15.
In fact, the world was divided into a rather small minority of “developed” countries and a rather huge majority of “developing” or “underdeveloped” countries; a process that succeeded in consolidating itself, despite the continuous ups and downs of the industrial, capitalist economy. In particular, the 1857 Depression put an end to the previous period of calmness, whereas, at the beginning of the 1860s, capitalism began once again to develop. During the years 1866–1868, there was noted a new depression, while during the years 1871–1873 economy went again out of the recession to be followed by the big 1873 crash and the so-called “Long Depression” during the 1870s and 1880s (Hobsbawm 1995).
- 16.
It is estimated that, during the period 1851–1880, approximately 5,300,000 people left the British Isles, while there was a huge flow towards the big urban and industrial centres.
- 17.
In 1851, only 20 % of the English population was employed in the sector of agriculture, falling to 16 % in the 1880s and reaching an even lower percentage of 10 % at the end of the century. On the contrary, in 1851, approximately 33 % of working people was employed in the industrial sector and another 14–15 % was employed as domestic servants, while another 32 % was employed in the mines, the transportations and the public sector. Even the quantity and content of the ‘Factory Acts’ were indicative of the significant transformations in people’s employment, during the second half of the nineteenth century (Marx 1982).
- 18.
London – the first European city that went beyond 1,000,000 inhabitants – reached 2,500,000 inhabitants in 1851, mounted to 4,500,000 in 1881 and to 7,000,000 in 1911. Around 1800, one in ten inhabitants of England and Wales was living in London, and one in five in 1900. During the years 1841–1851, approximately 330,000 immigrants arrived at London, in the 1850s another 286,000 and in the 1860s another 331,000.
- 19.
After the 1832, 1867 and 1884 ‘Reform Acts’, 29 % of the British male population obtained the right to vote.
- 20.
During the period 1888–1914, the number of workers organized in unions was raised from 759,000 to 4,100,000.
- 21.
In fact, they succeeded in entering into the circles of “successful”, well-respected citizens. However, as we are going to see in the third chapter, there were no distinctly discrete boundaries between social classes. Therefore, it became quite necessary to invent a whole range of identifiable criteria – among others, education, wealth and entertainment – not only between aristocracy and middle classes, but also between middle and lower social classes, even between the diverse strata of the working class itself.
- 22.
Of course, this new trend in favour of scientific medicine did not immediately exclude the existence of a variety of “unorthodox” methods and practices. After all, the nineteenth century bred the birth and expansion of alternative medicine. For example, in 1854, there were in Britain, at least, 6,000 “unorthodox” practitioners, whereas there were, on the whole, 17,000 professional doctors and surgeons (Brunton 2004). In any case, this fact reveals Victorian society’s burning interest in, and intense need for, the protection and improvement of its member’s life and prosperity in biological terms. The movement towards “scientific” medicine was just making its first steps.
- 23.
The invention of the stethoscope, in 1816, by R.T.H. Laennec (1781–1826) emerged as the landmark of clinical medicine, marking, at the same time, the international communication and exchange, not only of human beings and goods, but also of ideas and practices. Accordingly, the wide use of the microscope led to the emergence of the laboratory as the primary locus of medical research and experiments, especially, in mid-nineteenth-century Germany and France.
- 24.
It is noteworthy that until, at least, the end of the seventeenth century, surgeons had not enjoyed the high status and appreciation that they do actually enjoy nowadays. They used to form a common guild with barbers and their day-to-day business revolved around minor repairs limited to the exterior of the body, such as blood-letting, pulling teeth, applying ointments, treating skin ulcers, even managing whitlows and shaving. As a result, they were usually treated with contempt and mockery. During the eighteenth century, due to their more formal and specialized training and their dissociation from barbering, surgeons’ status improved noticeably. It is characteristic that in London, the Surgeons’ Guild split from the Barbers’ Guild in 1745 (Porter 1999; Schlich 2004).
- 25.
One of the most important steps towards surgery’s wide admittance was when Queen Victoria took chloroform for the birth of Prince Leopold, on 7 April 1853, while the work of Ignaz Semmelweis (1818–1865) and Joseph Lister (1827–1912) succeeded in coping with the problem of infection.
- 26.
At this point, we should stress that towards the end of the nineteenth century, many hospitals, as they were facing serious economic difficulties, began to anticipate from their patients to pay a small fee for the provided services. From the 1870s onwards, many hospitals provided special facilities for their paying patients, while, in the 1890s, about half of London’s hospitals were having facilities for paying patients. However, by the beginning of the twentieth century and the emergence of the modern welfare state that “took action” within western societies, even the working classes had to pay, at least, a small fee.
- 27.
In 1837, thirty-six doctors were living in Harley Street; in 1900, they were, almost, one hundred and fifty. Accordingly, both the foundation and circulation of new medical and scientific journals – during the nineteenth century, four hundred new titles appeared – and the realization of scientific congresses, fostered this new trend.
- 28.
It is worth mentioning that the doctor:population ratio in England and Wales was 1:1,392 in 1861, 1:1,547 in 1871, 1:1,721 in 1881 and 1:1,500 in 1891; a fact that exacerbated the intensity of competition.
- 29.
Quite indicative of the fierce competition between the various groups of medical specialists was also the case of female practitioners, who began entering the medical profession and being acknowledged in late nineteenth century, following the example of Elizabeth Blackwell (1821–1910) and Sophia Jex-Blake (1840–1912) in the medical field, and the leading work of Florence Nightingale (1820–1910) in the nursing field. In 1881, there were twenty-five women doctors in England and Wales, that is, 0.17 % of the profession, and by 1911, there were 495 women, constituting 2 % of the profession. However, their integration took place with a particularly great delay in comparison to their male fellows, with women facing extremely negative attitudes towards them – sometimes, even physical violence (Rhodes 2004; Carpenter 2010).
- 30.
“Περί μέν τῆς νούσου καλεομένης ὧδ’ ἔχει; οὐδέν τί μοι δοκέει τῶν ἄλλων θειοτέρη εἶναι νούσων οὐδέ ἱερωτέρη, ἀλλά φύσιν μέν ἔχει ἥν καί τά λοιπά νουσήματα, ὅθεν γίνεται. […]. Ἀλλά γάρ αἴτιος ὁ ἐγκέφαλος τούτου τοῦ πάθεος, ὥσπερ καί τῶν ἄλλων νουσημάτων τῶν μεγίστων”.
- 31.
In § 33, Herodotus explained that Kambysses’s fury was, probably, attributed to the sacred disease, that is, to hereditary epilepsy: “καί γάρ τινα καί ἑκ γενεῆς νοῦσον μεγάλην λέγεται ἔχειν ὁ Καμβύσης, τήν ἱρήν ονομάζουσί τινες”. On the other hand, according to Diogenes Laertius, Heraclitus was referring with the phrase “sacred disease” to conceit: “τήν τε οἴησιν ἱεράν νόσον ἔλεγε καί την ὄρασιν ψεύδευσθαι” (fragment 46). However, commentators are still arguing whether fragment 46 should be attributed to Heraclitus as a genuine fragment, or not (Kahn 1981).
- 32.
At this point, we should stress that many commentators have underlined that natural and supernatural, rational and religious attitudes coexisted in the explanation and treatment of the diseases in classical Antiquity, whereas both Hippocratic and Asklepian traditions were preserved in epilepsy’s confrontation. As Donald Todman remarks, “[a]lthough Hippocratic physicians used arguments to oppose religious views about epilepsy, it is clear that they were careful not to oppose religion itself. In The Sacred Disease supernatural theories are criticized but the concept of the divine is preserved” (Todman 2008: 440).
- 33.
Sakikku’s tablets are currently located at the British Museum, in London.
- 34.
The emphasis upon this “omission” has been made, in order to underline the fact that the Babylonian explanation of the disease, as it was the case with the medieval that followed, did present a rational structure and constitution. The contrast between Hippocratic and Babylonian thought – that is, between “rationality” and “irrationality” – and the concomitant criticism and categorization of a whole range of older theories and practices as “scientific” or “non-scientific” respectively, are the outcome of specific categorizations of modern western thought. The absolute, that is, rigid and strict, dichotomy between “rational” and “irrational” had already begun, from the early twentieth century, to be seriously refuted and reconstructed, with the writings of Paul Radin and later of Claude Lévi-Strauss and other thinkers (Kondylis 1998).
- 35.
The translation of Sakkiku into English was made by the authors of the article.
- 36.
“Όκόσοι δέ ἤδη ἐθάδες εἰσί τή νούσω, προγιγνώσκουσιν ὀκόταν μέλλωσι λήψεσθαι, καί φεύγουσιν ἐκ τῶν ἀνθρώπων, […]; τοῦτο δέ ποιέει ὑπ’ αἰσχύνης τοῦ πάθεος καί οὔχ ὑπό φόβου, ὡς οἱ πολλοί νομίζουσι, τοῦ δαιμονίου”.
- 37.
- 38.
Galen believed that the ideal doctor should also be a philosopher. From this perspective, he saw himself as a real student of both Hippocrates and Plato. Despite the severe prejudice against medicine and all medical practitioners, he succeeded in making a “career” in Rome.
- 39.
For Galen, diet consisted, in essence, of the so-called “six non-naturals”: (i) food and drink, (ii) environment, (iii) sleep, (iv) exercise, (v) evacuations (including sexual), and (vi) state of mind (Porter 1999).
- 40.
We should also stress that, even though from the late eleventh century onwards, a whole range of Greek medical treatises was translated from Arabic (the first systematic translations of Greek medical texts) into Latin and medical training was formally organized at the newly-founded universities, only a very few new elements were added to the understanding and treatment of the disease.
- 41.
It is characteristic that due to the religious and political controversies in England, during the sixteenth and seventeenth centuries, there were actually countless episodes as to whether someone suffering from seizures was an epileptic, as it was argued by Anglicans preachers and physicians, or demonic possessed, as it was argued by Puritans. Of course, the proposed treatment was based on the interpretation it was adopted – either with physical means or with exorcism by fasting and prayer.
- 42.
Regarding prophetic abilities, Mohammed had been the most characteristic case, while Julius Caesar was thought of as an epileptic of extremely high intelligence.
- 43.
Even until the end of the eighteenth century, there were cases where prison inmates facing the threat of tortures simulated epileptic seizures in order to avoid them. Moreover, when universal military conscription was introduced in several European countries, many people simulated epilepsy to avoid service. For this reason, the methods used for the unmasking of feigned epilepsy were manifold and did actually change over time.
- 44.
It is quite indicative that in Britain, even in the 1750s, less than two hundred and fifty madmen were confined in specialized institutions.
- 45.
In three out of his seven books, Willis focused on neurological issues; apart from Cerebri Anatome, he also wrote Pathologiae Cerebri and De Anima Brutorum, where he was analyzing several neurological disorders (epilepsy, apoplexy, paralysis of the insane, etc.).
- 46.
With the term “neurology”, Willis referred to the doctrine of the nerves as distinct from that of the brain.
- 47.
Of course, their efforts did not have always the desirable results, as it was the case with the 1662 ‘Act of Uniformity’ that created new problems rather than solving the existing ones.
- 48.
The transformations of the Scientific Revolution could be included into the more general atmosphere of the mid-sixteenth-century English society, where the emphasis was put upon the confrontation of any kind of dissenters and the restoration of order, as well as on political and social stability. Indicative examples of this trend were both the consolidation of the circulation of the blood by William Harvey (1578–1657) in 1628 – in direct relation to his conviction that the monarch was the heart of the body politic – and the following domination of the theoretical premises of Newton and Boyle, to which we have already referred to.
- 49.
“Ils ne doivent pas habiter pèle-mêle avec les aliénés, comme cela se pratique dans presque tous les hospices où l’on reçoit les épileptiques et les aliénés. La vue d’un accès d’épilepsie suffit pour rendre épileptique une personne bien portante. Combien plus grand est le danger pour un aliéné quelquefois si impressionnable! Que penser de l’indifférence avec laquelle on laisse errer ces infortunés qu’on rencontre sur la voie publique, et qui ne manquent jamais d’attirer autour d’eux un grand nombre de curieux, de femmes et d’enfans? Cependant la vue d’un accès d’épilepsie suffit pour rendre épileptique” (Esquirol 1838: 331).
- 50.
On 25 August 1793, Philippe Pinel took his office at Bicêtre Hospice. According to the myth, he liberated his patients from their chains, clearing the way for the abandonment of any kind of mechanical restraint and the adoption of more humane therapeutic means; however, this gesture should be attributed to the supervisor of the insane at Bicêtre, Jean Baptiste Pussin (1745–1811). In Britain, the foundation of the York Retreat in 1796, by the Tuke family (William, Henry, Daniel Hack and James Hack Tuke), after a Quaker patient’s mysterious death at York Asylum, was included in the same venture – as it was also the work of Vincenzo Chiarugi (1759–1820), in Florence.
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Lekka, V. (2015). “Bodies That Matter”: Living in the Nineteenth Century. In: The Neurological Emergence of Epilepsy. Boston Studies in the Philosophy and History of Science, vol 305. Springer, Cham. https://doi.org/10.1007/978-3-319-06293-8_2
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