A Statistical Inquiry Into the Nature and Treatment of Epilepsy Part 1

A Statistical Inquiry Into the Nature and Treatment of Epilepsy.

by Alexander Hughes Bennett.

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 a.s.sertions. 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 exact.i.tude. 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.

_s.e.x and s.e.xual Conditions._--In one hundred unselected cases of epilepsy there were--

Males, 47 per cent.

Females, 53 per cent.

showing that practically the s.e.xes 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:--

Males. Females. Total.

From 1 to 10 years 9 14 23 From 10 to 20 years 11 23 34 From 20 to 30 years 14 9 23 From 30 to 40 years 10 6 16 From 40 to 50 years 1 0 1 From 50 to 60 years 2 1 3

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 s.e.xes the disease rarely commences after forty. The following table shows the ages of the patients under observation:--

Males. Females. Total.

From 1 to 10 years 4 1 5 From 0 to 20 years 10 20 30 From 20 to 30 years 17 15 32 From 30 to 40 years 11 9 20 From 40 to 50 years 2 6 8 From 50 to 60 years 3 2 5

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--

Epilepsy in 63.4 per cent.

Insanity in 12.1 per cent.

Phthisis in 12.1 per cent.

Asthma in 2.4 per cent.

Apoplexy in 2.4 per cent.

Hysteria in 2.4 per cent.

Hemiplegia in 2.4 per cent.

Spinal complaint in 2.4 per cent.

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 cla.s.sified 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:--

Father in 11.5 per cent.

Mother in 7.6 per cent.

Father, mother, and brother in 3.8 per cent.

Mother and child in 3.8 per cent.

Grandmother, mother, and two sisters in 3.8 per cent.

Mother and sister in 3.8 per cent.

Grandfather in 7.6 per cent.

Grandmother in 3.8 per cent.

Brother in 11.5 per cent.

Sister in 11.5 per cent.

Two brothers in 3.8 per cent.