Background History

About Epilepsy

Background History

Historical background
of epilepsy

The Sacred Disease, or epilepsy, as it is called today is as old as man himself. As early as 2080 BC, Hammurabi, King of Babylon, made mention of it in his laws. Then, as now, it assumed both medical and social importance.

The laws demonstrated that the prejudice existed, even then, against the person with epilepsy. For example, two of the sections of the “Code of Hammurabi” curtailed the rights of people with epilepsy in what we would describe today as basic human rights. A person with epilepsy was not allowed to marry and could not act either as a member of a jury or as a witness in a court of law.

In approximately 400 BC in the Hippocratic collection of medical writing on the Sacred Disease an alternative explanation to superstitions associated with epilepsy is given. The explanation given is that epilepsy is caused by an excess of phlegm. However, superstition remained and many strange customs evolved.

Roman Times

A Roman custom was to spit on seeing an epileptic seizure in the belief that this would keep the demon away and thus avoid infection. The Romans called the condition “Morbis Comitialis” meaning that it was the disease which interrupted the proceeding of the comitia in the assembly of the people. An explanation of the name given comes from the writings of the poet of the 3rd century Quintus Serenus:

“A kind of sudden sickness, tis whose name has clung since the votes of a true count it prevents…”

For people with epilepsy life was miserable and they were subject to extreme degradation. To the public they were merely objects of horror and disgust. The Roman author Apuleius, when writing about a slave boy, Thallus, said that fellow slaves would have nothing to do with him because of his epilepsy:

“Nobody dares to eat with him from the same dish or drink from the same cup lest he contaminate the family.”

The misconception that epilepsy was a form of lunacy continued in the second and third centuries. Both philosophers and physicians connected the condition with lunar phases. This was because many other illnesses affecting the mind and showing regular patterns of disturbance were linked with the moon.

With the spread of Christianity saints were adopted as being the patrons of those afflicted with what was now called the “falling sickness”. The most popular of these saints was St Valentine. Pilgrims were taken to the Priory of St Valentine in the hope of finding a cure. Many rubrics were followed, the centre of these being the celebration of as many as three masses, and it was essential that a visit was made to the grave of the Saint. Hospitals for people with epilepsy were built at such centres of pilgrimage.

Treatment for the condition became wide and varied. One of the more bizarre sets of instructions for dealing with a person during a seizure was written by a fifteenth century lecturer in medicine. Antonius Guainerius:

“If a paroxysm comes to an epileptic, let it be your aim to prevent the ascent of vapours, and as far as possible to draw the matter downwards. Therefore perform vigorous rubbings or painful ligatures on the extremities, on the buttocks, under the knee make a slight incision with a cupping glass; and call the patient in a loud voice by his own name."

“Place a wooden peg between his teeth. Also when an epileptic falls, at once kill a dog, and give the gall to the patient in any way that you can. If the one who first sees the attack urinates in his own shoe and then stirs around as if to wash it, then afterwards the patient will be entirely delivered.”

He also made recommendations for the treatment to be taken during inter-seizure periods. Here he instructed the unfortunate sufferer to “Avoid fear, sadness, anger and all disturbances to the soul, also coitus, unless he be a robust youth, accustomed to it; he may have intercourse lest his semen be turned into poison by being too long retained.”

It was also recommended that tablets could solve all problems of any curable epilepsy. These tablets were made from substances such as …the rib of the left side of a man who has been hanged, or beheaded, and give it to the patient every morning for a month, it should be taken with water. Needless to say not a great deal of success was achieved.

Medieval Times

Surgical methods of curing epilepsy were primitive in medieval times. The most popular course of action was to use cauterisation. Hot irons were applied to the head and surrounding areas. Perhaps the most understandable surgery was that of making a hole in the skull so that offending matter could make its escape.

17th Century

In the seventeenth century physicians would no longer use methods such as those described by Guainerius and, while the search went on for a greater understanding and a more successful form of therapy physicians would not use such materials as blood, urine and dung etc.

18th Century

General attitudes towards the epileptic patient gradually improved during the eighteenth century. Contradictions were being made to the popular belief that the epilepsy was infectious (which even today is believed by some) and so the patients were no longer locked in wards in very bad conditions. The sight of an epileptic patient being shackled to the wall thankfully became more infrequent.

19th Century

It was in the 19th century that the first major break-through in antiepileptic therapy was achieved. The discovery of potassium bromide as an antiepileptic drug occurred by accident. It was popularly supposed by Victorian moralists that epilepsy came from an excess of sexual activity. It was for this reason that it was generally believed that castration was the only true answer to the problem.

In the National Hospital, Queen Square, London, patients suffering from sexually transmitted diseases were being treated with bromide because of its property of causing temporary impotence. It was noted that patients who were also suffering from epilepsy showed a marked decrease in their seizure patients. Hence the discovery of the first truly antiepileptic drug. It became so popular that enormous doses of bromide were being prescribed.

At one stage 2 tonnes of bromide was being used annually in the treatment of epilepsy at the National Hospital alone. Unfortunately there were side effects which are probably best described by quoting from Hammond, as he exhibited a patient in New York:

“As you see he is broken down in appearance, has large abscesses in his neck and is altogether in a bad condition. But this is better than to have epilepsy.”

People did not agree that these side effects were better than having epilepsy and so the use of the drug was gradually withdrawn. It was, however, a great step forward.

At about this time a German scientist, Van Boyer was experimenting with a drug, Luminal, which is better known as Phenobarbitone. He was using this drug as a sedative and in this sphere it proved to be very successful. However, it was not until 1912 that another German, Alfred Hauptman, advocated its use as an antiepileptic drug. It proved to be a great success and more details of the effect of Phenobarbitone will be given later.

Hughlings Jackson

Probably one of the greatest contributions to a greater understanding of epilepsy was made by an English physician, Hughlings Jackson, who produced the findings of his work in 1870.

His interest in the condition was stimulated by a form of epilepsy demonstrated by his wife. This unusual type of epilepsy begins with a twitch in the big toe or the thumb and spreads so that the whole leg or arm becomes involved.

This type of epilepsy is now known as Jacksonian epilepsy. Jackson devoted most of his working life studying epilepsy and his name is synonymous with the condition.

20th Century and Modern Medicine

In 1929 Hans Berger discovered that the minute electrical discharges from the brain could be recorded and measured on a machine called an electroencephalogram and this was to prove to be an enormous help in the diagnosis of epilepsy.

In recent years new drugs have been discovered, surgical methods have been pioneered and great advances have been made in diagnostic technology. However, there are still enormous social problems to be faced by people with epilepsy in the fields of education, employment and, not least, from the prejudices of those around them.