Abstract
This chapter focuses on the epistemological approach and analysis of the medical files of John Hughlings Jackson’s epileptic patients, who were hospitalized at the National Hospital for the Paralysed and Epileptic, during the period 1870–1895. More particularly, it examines and evaluates the time between epilepsy’s first manifestation and the patients’ admittance to the National Hospital, the length of their hospitalization, the prescribed treatment, the result of hospitalization, as well as the ways of epilepsy’s and epileptic seizures’ presentation and representation in the hospital’s medical files. From this perspective, it attempts to inscribe the aforementioned elements within the dominant nineteenth-century neurological discourse; to this direction, it proceeds with their comparative juxtaposition with contemporary medical journals and treatises, as well as with the medical files of the two private institutions that were also examined, the Manor House Asylum and the Holloway Sanatorium. Having the National Hospital’s medical files and epilepsy’s case as a starting point, and exploring Jackson’s neurophysiology, the “epistemological” part of this book attempts to depict this major turn towards the scientific study and systematic exploration of the human brain that marked the second half of the nineteenth century.
Medicine is the most closely linked to the whole of culture,
every transformation in medical conceptions being conditioned
by transformations in the ideas of the epoch.
E. Sigerist, Einführung in die Medizin
Disease is a general concept of non-value
which includes all possible negative values.
K. Jaspers, Allgemeine Psychopathologie
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Notes
- 1.
At this point, we should stress not only the difficulties in defining strict epidemiological statistics for a multidimensional disorder as epilepsy, but also the variations according to specific geographical regions, specific types of epilepsy, as well as gender, age and ethnicity. According to recent studies, European countries, North America and Australia present similar rates; about 7 % per 1,000 inhabitants is having active epilepsy, while in less developed countries (i.e., South and Central America, Africa and Asia) the prevalence rates are distinctly higher (Forsgren <CitationRef CitationID="CR39” >2004</Citation Ref>; Sridharan <CitationRef CitationID="CR138” >2002</Citation Ref>).
- 2.
“Οὕτως ἡ νοῦσος αὕτη γίνεται καί θάλλει ἀπό τῶν προσιόντων τε καί ἀπιόντων”.
- 3.
At this point, it should be noted that there has been a great debate among social and economic historians regarding the issue of the living conditions of the English population, during the nineteenth century. On the one hand, several historians have asserted that there had been an improvement in the living conditions, mainly, in reference to the nutritional habits and the more general living conditions that led to a concomitant decline in mortality levels. This process has been mainly attributed to the development of the sector of “public health” and to the new scientific discoveries. On the other hand, other historians have stressed the improvement of the living conditions of a significant part of the English population – that is, the upper and middle social classes – and the simultaneous, essential deterioration of a great majority – that is, the lower social classes – due to the continuous and incessant industrial expansion and development, and the consequent mass labour and exploitation of human beings, focusing not only on the economic, but especially on the social ramifications of the Industrial Revolution (Hobsbawm <CitationRef CitationID="CR63” >1979</Citation Ref>; Szreter <CitationRef CitationID="CR143” >1988</Citation Ref>; Winter <CitationRef CitationID="CR156” >1982</Citation Ref>; Thompson <CitationRef CitationID="CR145” >1991</Citation Ref>; Woodward <CitationRef CitationID="CR158” >1984</Citation Ref>).
- 4.
During the last decades, several studies have focused on both the concept of “medicalization” and its implication in western societies at the beginning of the twenty-first century, and the usually positively charged concept of “de-medicalisation”. As Peter Conrad has underlined, “‘[m]edicalization’ describes a process by which non-medical problems become defined and treated as medical problems, usually in terms of illness and disorders” (Conrad <CitationRef CitationID="CR33” >2007</Citation Ref>: 4; Conrad <CitationRef CitationID="CR32” >1992</Citation Ref>; Nye <CitationRef CitationID="CR105” >2003</Citation Ref>).
- 5.
The ‘Public Health Acts’ covered a whole range of issues in reference to the sector of public health; the problem of epidemic diseases, the contamination of water and food, the hygiene within hospitals, the working class residences, the working environment in factories, were just some of the main issues that concerned the public health reformers.
- 6.
At this point, we should once again invoke Max Weber and his analysis on the concept of the “professional calling”: “And in truth this peculiar idea, so familiar to us to-day, but in reality so little a matter of course, of one’s duty in a calling, is what is most characteristic of the social ethic of capitalistic culture, and is in a sense the fundamental basis of it” (Weber <CitationRef CitationID="CR153” >1992</Citation Ref>: 19).
- 7.
The following abstract from the report of the ‘Committee of the Baking Trade in Ireland’, for the year 1861, is especially representative: “That work beyond 12 hours has a tendency to undermine the health of the working man, and so leads to premature old age and death, to the great injury of families of working men, thus deprived of the care and support of the head of the family when most required” (Marx <CitationRef CitationID="CR104” >1982</Citation Ref>: 362). Besides, we should not forget that some years earlier the 1844 ‘Factory Act’ had already attempted to abolish women’s night shifts; it also restricted their working day to twelve hours and proceeded to a further reduction (ten hours) in 1847 (Fuchs <CitationRef CitationID="CR49” >2005</Citation Ref>).
- 8.
One “drachm” (“dram”) is amounted to 3.8879346 g, and one “grain” to 0.06479891 g.
- 9.
At this point, it should be mentioned that, until the mid-nineteenth century, hypnotism and magnetism constituted quite popular methods of treating epileptic, hystero-epileptic and hysteric seizures. An invention of the German physician and astrologer Franz Anton Mesmer (1734–1815), the connection between hypnotism, and epilepsy and hysteria – through the inducement of artificial seizures, so as the disease could reach its peak and, in this way, the patient could be fully cured – would dominate, especially, in the French thought, until the end of the century. Many famous people, such as Jean-Martin Charcot, Honoré de Balzac, Alexandre Dumas, even Charles Dickens, were actually fascinated by hypnotism and resorted to its methods (Thornton <CitationRef CitationID="CR147” >1976</Citation Ref>; Scott <CitationRef CitationID="CR126” >1993</Citation Ref>).
- 10.
One extremely characteristic example was the well-known debate with Isaac Baker Brown, in the mid-1860s. Isaac Baker Brown (1811–1873) was a doctor and surgeon, founder of the London Surgical Home, in Notting Hill. He was using the method of clitoridectomy, in order to treat his patients who were suffering from epilepsy, hysteria and catalepsy. In 1866, he had published a treatise, where he claimed that his method had been proven successful in 70 % of the total number of cases. The resort to this particular practice had raised a storm of reactions and protests, since the issue was not just clitoridectomy as a surgical practice per se, but, primarily, the way and exact conditions under which it was taking place. The notion of the patient’s consent – or the family’s consent in cases he/she was not able to decide – was emerging as a matter of highly special importance for surgery.
- 11.
At this point, it should be noted that an analogous debate came along, in the 1870s and 1880s, when, after the abandonment of the so-called “mechanical restraint”, those suffering from mental disorders were treated and, to a great extent, restricted through the use of sedatives – such as ether, potassium bromide, chloral, chloroform, etc. There came to the forefront both the issue of the consent of psychiatric institutions’ inmates and the question about the need of the so-called “chemical restraint” for the attainment of their discipline.
- 12.
As it has been rightly asserted, “[a]lthough localisation theories were being worked on in other countries at this time, it was at Queen Square that this work developed in its most widely propagated form” (Stirling <CitationRef CitationID="CR141” >2010</Citation Ref>: 20).
- 13.
As we have already mentioned in the third chapter, the various examinations were carried out by specialized doctors; for example, Dr. Gunn was responsible for the examination of the eyes, Dr. Semon for the examinations of the larynx, etc. At the same time, there were invented and adopted diverse ways of examining the patients’ general condition. For instance, when the patient was also suffering from another disease, such as paralysis or hemiplegia, there were examined the movement and function of his/her upper extremities, through the deposit of his/her writing specimen and signature.
- 14.
Accordingly, in 1880, B. Bramwell, in a lecture in the Extra-Academic School of Medicine, in Edinburgh, referred quite detailed to the scientific methods and the necessary practical steps, in order to proceed to the differential diagnosis of epilepsy (Bramwell <CitationRef CitationID="CR25” >1880</Citation Ref>).
- 15.
At this point, it should be noted that the concept of visibility and the significance it was attributed to it had begun, to a great extent, with the philosophy and work of the English philosopher Jeremy Bentham (1748–1832) and, especially, with the design of the Panopticon (1785); namely, the famous prison, where the prisoners were visible from every single part of the building, without being able to see and understand who was watching over them and who was controlling them, at all times (Foucault <CitationRef CitationID="CR40” >1991</Citation Ref>, <CitationRef CitationID="CR47” >2006</Citation Ref>).
- 16.
A very representative example of this emphasis upon visibility and its significance was the development and expansion of the glazing industry, especially, from the late-eighteenth and the beginning of the nineteenth centuries onwards. The wide use of glass did actually imply the creation of a kind of visual economy where everyone and everything were, at all times, visible and accessible (Otter <CitationRef CitationID="CR111” >2002</Citation Ref>).
- 17.
“Kατά ταῦτα νομίζω τόν ἐγκέφαλον δύναμιν πλείστην ἔχειν ἐν τῷ ἀνθρώπῳ”.
- 18.
Gall made chiefly his researches by examining, through cranioscopies, the brains of the inmates in German prisons, around 1805. Through the method of cranioscopy, he believed that he could read a person’s personality on the external surface of its scull. In this way, he located twenty-seven bumps that corresponded, to his view, to the twenty-seven fundamental qualities of the human personality (Wetzell <CitationRef CitationID="CR154” >2000</Citation Ref>; Lekka <CitationRef CitationID="CR99” >2012</Citation Ref>).
- 19.
That is, in the same way that economists, at the beginning and the middle of the century, tried to base their economic theory on the indisputable reality and worth of nature, and, in effect, rendered the dominance of the self-regulated market within society an inevitable and “natural” necessity (Polanyi <CitationRef CitationID="CR112” >2001</Citation Ref>).
- 20.
In this way, the gradual detachment from the values of work and professional calling, the erosion of the bourgeois family and the concomitant emancipation of women, the fragmentation of bourgeois/liberal politics and the simultaneous appearance of nationalistic movements were all part of this wider climate of unrest, intensifying the worries of the middle and upper social classes in late Victorian Britain.
- 21.
At the same time, the rising and deafening demand of the workers for the eight-hour day was already echoing from the other side of the Atlantic (Green <CitationRef CitationID="CR53” >2006</Citation Ref>).
- 22.
Of course, we should note that their significant contribution and preeminence did by no means imply that they did not present several divergences in their theoretical prerequisites and methods. Among others, a characteristic example is the significant differentiation between Gowers and Jackson; as Jeannette Stirling underlines, regarding the ways the epileptic patient was represented, “[d]espite their shared codes of knowledge and a shared socio-cultural framework, Gowers and Jackson see and register significantly different versions of the epileptic” (Stirling <CitationRef CitationID="CR141” >2010</Citation Ref>: 20).
- 23.
At the same time, John Hughlings Jackson’s theory has been described as “too mechanistic” to be used by psychiatry (Dewhurst <CitationRef CitationID="CR36” >1982</Citation Ref>).
- 24.
However, we do not know with certainty whether they did actually meet during this period, or not.
- 25.
As he defined it for the first time in The Principles of Biology, “this survival of the fittest, implies multiplication of the fittest. Out of the fittest thus multiplied, there will, as before, be an overthrowing of the moving equilibrium wherever it presents the least opposing force to the new incident force. And by the continual destruction of the individuals that are the least capable of maintaining their equilibria in presence of this new incident force, there must eventually be arrived at an altered type completely in equilibrium with the altered conditions. This survival of the fittest, which I have here sought to express in mechanical terms, is that which Mr Darwin has called ‘natural selection, or the preservation of favoured races in the struggle for life’” (Spencer <CitationRef CitationID="CR135” >1864</Citation Ref>: 444–445).
- 26.
At this point, let us remember Darwin, who maintained that “for, as varieties, in order to become in any degree permanent, necessarily have to struggle with the other inhabitants of the country, the species which are already dominant will be the most likely to yield offspring which, though in some slight degree modified, will still inherit those advantages that enabled their parents to become dominant over their compatriots” (Darwin <CitationRef CitationID="CR35” >1859</Citation Ref>: 54).
- 27.
It should not be considered as accidental that, in 1883, within the frame of the attempt to relive, retain and continue the hierarchical organization and structure of the English society, the conservative ‘Primrose League’ was founded. It was the largest political organization in Britain in the 1890s, when she had more than one million members. As it has been underlined by David Cannadine, “it was a most successful instrument in promoting, […], a hierarchical cast of mind and a hierarchical view of the British social world” (Cannadine <CitationRef CitationID="CR30” >1998</Citation Ref>: 122). Accordingly, during this period, it was noted a renewed interest in the exhibition of any symbols of hierarchy, such as town halls ornamented with statues of historic figures, regalia, maces, etc.
- 28.
These censuses were repeated every ten years until 1901. It is worth noting that, in the 1841 census, it was attempted, for the first time, to record the total of the population according to its profession. This process led, in 1851, to the first attempt of a scientific analysis of these particular data, while in 1891, there was given a general view of all students.
- 29.
Of course, during the first decades of the public health reform, the attempts of the liberal state concerned and, essentially, improved the living conditions of the middle and upper social classes.
- 30.
On the one hand, the new politics led to the provision for a national, free insurance that was officially recognized in Britain in 1911, with the ‘National Insurance Act’, which is today considered as one of the first steps that paved the way for the foundation of the NHS. On the other hand, between the years 1848–1872, there were given to local governments more than 11,000,000₤ for health issues, while, during the next eighty years, the Local Government Board approved the double amount of money.
- 31.
During that same period, there was noted a respective revival of state interventionism in economy. The Long Depression of the 1870s and 1880s had led to a relative and, probably, fatal depreciation of the liberal principles, which, had been, in essence, “the anarchism of the bourgeoisie and, as in revolutionary anarchism, it had no place for the state” (Hobsbawm <CitationRef CitationID="CR64” >1989</Citation Ref>: 40).
- 32.
It should be stressed that the fears regarding the British population’s national degeneration were strongly intensified after the Boer War of 1899–1902 (Turda <CitationRef CitationID="CR148” >2010</Citation Ref>).
- 33.
The list of those who should be included in the law on compulsory sterilization was extremely extensive and included: those suffering from epilepsy, leprosy, cancer, idiocy, imbecility, lunacy, organic disease of the heart, of the lungs and of the kidneys, prostitutes, vagrants, criminals, those suffering from venereal diseases, as well as “dull” and “weak-minded” children (Rentoul <CitationRef CitationID="CR116” >1903</Citation Ref>).
- 34.
In 1907, the state of Indiana established the first law on compulsory sterilization of habitual criminals, rapists, lunatics, epileptics and idiots. Until 1917, eleven more states followed the example of Indiana and fifteen more until 1918. On the whole, during the twentieth century, thirty states established laws on the sterilization of mentally defectives.
- 35.
The coordinated attempts of the advocates of eugenics, on the one hand, and the institutionalization of the 1913 ‘Mental Deficiency Act’ (Leach <CitationRef CitationID="CR98” >1914</Citation Ref>), on the other hand, played a significant role in the abandonment of the sterilization proposals.
- 36.
Besides, we should keep in mind that both the concept of the norm and the concept of the population were prevailing among the basic concepts of the emergent eugenics that was beginning to dominate in late nineteenth-century scientific discourse and that relied on the state’s intervention for the accomplishment of its scientific/biological programme (Rose <CitationRef CitationID="CR120” >1985</Citation Ref>; Turda <CitationRef CitationID="CR148” >2010</Citation Ref>).
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Lekka, V. (2015). Epilepsy in the Age of Neurology. 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_5
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