A Statistical Inquiry Into the Nature and Treatment of Epilepsy   By: Alexander Hughes Bennett

INTO

THE NATURE AND TREATMENT

OF

EPILEPSY

BY

A. HUGHES BENNETT, M.D.,

PHYSICIAN TO THE HOSPITAL FOR EPILEPSY AND PARALYSIS, AND ASSISTANT PHYSICIAN TO THE WESTMINSTER HOSPITAL.

LONDON

H. K. LEWIS, 136, GOWER STREET, W.C. 1884.

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

CONTENTS.

I. AN INQUIRY INTO THE ETIOLOGY AND SYMPTOMATOLOGY OF EPILEPSY.

II. AN INQUIRY INTO THE ACTION OF THE BROMIDES ON EPILEPTIC ATTACKS.

III. AN INQUIRY INTO THE EFFECTS OF THE PROLONGED ADMINISTRATION OF THE BROMIDES IN EPILEPSY.

I.

AN ENQUIRY

INTO THE

ETIOLOGY AND SYMPTOMATOLOGY

OF EPILEPSY.[A]

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

Males, 47 per cent. Females, 53 per cent.

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

Unmarried, 58.5 per cent. Married, 41.5 per cent.

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

The attacks were uninfluenced by marriage in 68.1 per cent. The attacks were diminished after marriage in 27.2 per cent. The attacks were increased after marriage in 4.5 per cent.

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

Children in 82.3 per cent. No children in 17.6 per cent.

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