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  A STATISTICAL INQUIRY

  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:--

                                   Males.  Females.  Total.

  From     1 to 10 years               9      14       23
  From    10 to 20 years              11      