The History of Modern Epilepsy: The Beginning, 1865-1914 (review)

The History of Modern Epilepsy explores the thinking, accomplishments, and attitudes during what the author calls the beginning of modern epileptology. Walter Friedlander first discusses how epilepsy was defined and diagnosed, which was difficult and arbitrary at best. He does a thorough job of pulling together the thinking of the prominent physicians throughout North America and England on what exactly constituted an epileptic seizure, as well as the many and varied thoughts on the pathology of epilepsy. During this time there were "neuronists," "antineuronists," "ponsmedullaists," and "cerebralists" (among others), and there was not one commonly accepted explanation for epilepsy. I liked his phrasing of the situation—"Living in a game room full of pieces from old jigsaw puzzles may be fun, but it also is frustrating" (p. 49)—to explain how those struggling to understand this disease must have perceived it.

Dr. Friedlander goes on to discuss the classification and etiology of epilepsy during this time period, as well as diagnostic criteria and treatment options. The treatments for epilepsy throughout history were creative and mostly ineffective. By the first half-century of modern epileptology, some physicians despaired of any effective treatment—yet they persisted in trying bromides, solanaceous drugs, zinc, iron, ergot, borax, digitalis, valerian, coal-tar products, sulphonal, strychnine, diets, purges, and various surgical procedures. Institutional treatment and electricity became more frequently used in the latter half of this beginning period.

The last third of the book is spent discussing the psychological and societal aspects of epilepsy from 1865 to 1914. The story gets more interesting and thought provoking as Friedlander presents the ideas of epileptic insanity, dementia caused by epilepsy, and the personality characteristics of patients with epilepsy. The story then segues nicely into the eugenics movement, which is very disturbing in light of what happened in the twenty-five years after this time period. Education, occupations, and family relationships are briefly discussed, but the way in which the legal system alternately excused or blamed epileptics for crimes is covered in more detail. The lack of agreement among physicians about the true nature of epilepsy made it very difficult for the medical and legal professions to reach consistent conclusions regarding the role of epilepsy in criminal behavior. Quite a few cases involving epileptics and violent crimes are cited, with many different opinions and no consistent conclusions. Reading the attitudes and opinions of society then and comparing them to the attitudes and opinions of society today makes one realize how far we have come and how far we have yet to go.

The author's conclusions regarding the first half-century of modern epileptology are that while not much was done clinically, the big contribution was the work toward understanding the pathophysiology. The ideas of nerve impulse transmission, inhibitory nervous function, chemical neurotransmitters, and brain electrical activity were all begun in this time period. There was much left to learn, but great progress had been made.

The writing style is a little dry throughout the book, but the attention to detail is praiseworthy. The author sums up his points well and the book's layout is cohesive and well thought out. Overall, it is a worthwhile read for anyone interested in understanding the beginning of modern epileptology.