“Scarcely a week passes but public feeling is startled, shocked, or more commonly outraged, by the appearance in the daily newspapers of alleged charges of indifference, cruelty, or neglect on the part of the authorities of one or the other of the metropolitan hospitals” (Anonymous 1877: 584; emphasis added). And, some years later: “[a] general hospital makes no distinction between the thriftless and the thrifty in the hour of need. Hour after hour, day after day, year after year, it stands, ready to bestow the best medical advice and the kindliest compassion on all who may cross its threshold. A man may pass his whole lifetime, and never think once seriously about the hospital, or bestow a sixpence upon it. Yet all this while the door has remained open night and day ready to receive him should bodily harm ever befall him, and the benevolence of the more thoughtful has kept in motion the machinery of medical talent and nursing skill, in spite of inadequate funds and lagging contributions” (Anonymous 1886: 1195).

The above abstracts from two articles published in the Lancet reflected the widespread attitudes and dominant convictions, at least, within the frame of the educated, middle and upper social classes, regarding the hospitals’ presence and indisputable contribution to the improvement of the quality of Victorian people’s health. Thus, the first article, published nine years before the second, attempted to rebut a series of supposed accusations concerning doctors’ and nurses’ mistakes, trying, at the same time, to praise their altruist offer and contribution. Even though, in the following decades, there was still a divergence of views and a concomitant appeal to hospital – as well as, school, prison, asylum, etc. – reform, the hospital as a concept, as a practice and as an institution had, already since the eighteenth century, intruded into English society and penetrated the daily life of the population throughout the nineteenth century; a direct outcome of the new necessities of the capitalist, industrialized society and its urgent imperative for healthy, robust and productive bodies. For this very reason, the medical files of the National Hospital for the Paralysed and Epileptic, no matter how fragmentary and sketchy they might appear – and they probably are according to modern scientific standards – do actually prove to be one of the most valuable guides towards the construction of a sociology of epilepsy and epileptics in late Victorian England.

After the chronological presentation of the medical files in the previous chapter, we are going to examine the 371 epileptic patients treated by John Hughlings Jackson during the period 1870–1895, in reference to their gender, age, marital status, occupation and address of residence, as well as to any references to the thoughts and feelings of both patients, and doctors and nurses.

To begin with, regarding epileptic patients’ gender, we discover, at once, an almost total balance. In a total of 371 epileptic patients treated by Jackson, 186 were men and 185 were women [Table 4.​1]; this balance was also apparent in a diachronic, comparative analysis of these elements, as we saw in the third chapter. In this way, one can deduce that epilepsy was – and, quite obviously, was treated as – a disease that could affect both genders, and not as an exclusively male or female disease.

In his famous 1880 ‘Gulstonian Lectures on Epilepsy’, at the Royal College of Physicians in London, Sir William Richard Gowers, one of the most eminent physicians at the National Hospital, referred to his epileptic patients’ gender. According to his medical files, in a total of 1,450 cases, 46.6 % were men and 53.4 % women (Gowers 1880). Additionally, he stressed that the divergence was becoming even smaller, if one took into account the fact that in female patients there were also included those who were suffering from hystero-epilepsy; without them – that is, in cases of “pure” epilepsy – male patients were 48 % of the total number of epileptics and female patients 52 %. So, there was noted a relative balance between the two genders. Of course, this equilibrium was not restricted within the walls of the National Hospital for the Paralysed and Epileptic. One can notice the same balance in the case of the one hundred “selected cases of epilepsy”, treated by A. Hughes Bennett; from those, 47 % were male and 53 % were female (Bennett 1884). Accordingly, the same balance between the two genders can be found in the case of the fifty-two patients, treated by E.H. Sieveking; 53.84 % of the patients were male and 46.15 % female (Sieveking 1857).

It should be highlighted that epilepsy’s perception as a neurological disorder that can equally affect both genders is still dominant in contemporary medical discourse. A quick look upon twenty-first-century neurological and neurosurgical treatises is enough to point out that the overwhelming majority does not proceed to a clear-cut distinction between male and female epileptic patients; that is, they do not particularly refer to the percentage of male and female epileptics – as it was the case with Gowers, Hughes Bennett and Sieveking – and, especially, to any kind of differentiations concerning the types of seizures in male and female patients, their frequency, the exact symptoms, etc. The most usual and common references, which are included and underlined in the twenty-first-century neurological discourse, are about the differentiations between epileptic children and epileptic adults, between those who experience just one epileptic seizure in their lifetime and those suffering from chronic epilepsy, between those suffering from epilepsy with a definite etiology and those suffering from the so-called “idiopathic epilepsy”, etc. (Epilepsy Foundation 2008; Blackburn 2003). The only references to epileptic patients’ gender, that is, mainly, to the female dimension of the disease, are in regard to the hormones’ influence upon epilepsy, and vice versa, to the connection between menstruation and epileptic seizures, to the genetic predisposition of epilepsy and the possibility of pregnancy by epileptic women, to the effects of seizures on the foetus, as well as to antiepileptic drugs’ side-effects on the foetus (i.e., malformations, growth retardation, etc.), to the risks of breastfeeding, to the course of epilepsy during menopause, etc. (Tomson 2004; Epilepsy Action 2008a; Epilepsy.com 2008). On the other hand, even if the percentage of male epileptics, at least, in Great Britain, is today a little higher in comparison to that of female epileptics, there are only but a few specialized references to male epilepsy; the vast majority is restricted to issues of sexual behaviour and sexual function/dysfunction, which can also affect women with epilepsy (Epilepsy Action 2008b; Tatum et al. 2009).¹

The above observations “compel” us to proceed to a short, but necessary, digression, as they put forward the issue of the controversial and, quite often, turbulent relationship between epilepsy and hysteria; a relationship that undoubtedly marked neurology’s – and, principally, psychiatry’s – first steps. This controversial relationship was, to an extent, based upon, and evolved around, the gender dimension of these disorders; for, on the one hand, there has been epilepsy, and, on the other hand, there has been hysteria, the “female” disease par excellence. The beginning of this distinction can already be found in the Hippocratic attribution of hysteria to the so-called “wandering womb”, which, due to its lightness and dryness, was wandering around the body and was causing all these symptoms; this is why the disease was later known as “hysteria”, as it was a disease stemming from the “ὑστέρα” (“hystera”) – that is, the Greek word for the uterus. Despite the fact that it was attributed to the brain by Edward Jorden (1569–1633), Thomas Sydenham (1624–1689) and Thomas Willis (1621–1675) during the seventeenth century, hysteria – this “mocking bird of nosology” (Faber 1997: 280), as it has been called in the mid-nineteenth century, due to its capability of imitating other diseases – and its historical course were entirely constructed through, and identified with the female body and gender (Sydenham 1848; MacDonald 1991; King 1993; Scull 2009). It has been also asserted that the history of hysteria has constituted one of the most dynamic and, at the same time, most dramatic expressions of the so-called “patriarchal medicine”, which attempted to continuously and most clearly manifest women’s “inferior” position and role within society, as well as the dangerousness of their sexuality and the imperative need for their subjugation to the current social and gender norms. For instance, the religious and political conflicts in sixteenth- and seventeenth-century England were quite indicative of this trend. Within the frame of these fierce controversies, where demonic possession was the only alternative explanation and exorcism the only alternative means of treatment in cases of unexplained fits and “extraordinary” diseases, men were viewed and treated either as demonic – in case the diagnosis was made by a cleric – or epileptic/melancholic – in case the diagnosis was made by a physician – and women were viewed and treated either as demonic or as hysteric, respectively (MacDonald 1991; Jorden 1991; Harrison and Westaway 1996).

At this point, it should also be stressed that the Franco-German medical tradition succeeded in dominating on the nineteenth-century theoretical and clinical work on hysteria, at first, through the work of the French neurologist Jean-Martin Charcot (1825–1893),² and, then, through the work of Sigmund Freud (1856–1939) (Freud 2013; Freud and Breuer 2004). At the same time, it was the English neurology that did, in fact, dominate on the theoretical and clinical work on epilepsy, which, during that same period, was steadily augmenting. These particular implications that have accompanied hysteria until our days, in combination with the decline of the medical/neurological interest in hysteria during the late nineteenth century (Micale 1993),³ do, in fact, constitute the main reasons why we do not proceed to hysteria’s comparative analysis with epilepsy – even though there are in the National Hospital’s medical files cases of hysteria – as it would be without any real theoretical and practical interest in our research.

Before completing our analysis of epileptic patients’ gender, it is worth proceeding to a, rather brief, comparative analysis between the National Hospital and the two private institutions that were examined. The first institution was the Manor House Asylum.⁴ The Manor House Asylum was a private, mental asylum, in Middlesex. It was founded by E.F. Tuke (1776–1846), whose work was then continued by the famous, philanthropist, Quaker family of the Tukes; the Tuke family was, among other things, the one that led to the foundation of the pioneer York Retreat, in 1796. In 1893, the Manor House Asylum was transferred to Chiswick House and became later known as the Chiswick House Asylum. On the whole, there were examined the medical files of one hundred and ninety-two patients, one hundred and fifteen men and seventy-seven women, during the period between May 1870 and October 1884. Out of these one hundred and ninety-two patients, twenty-three were recorded as having experienced, during their lifetime, one or more “epileptic fits”, or “epileptiform seizures”, or “attacks of epilepsy”. From these twenty-three epileptic patients, twenty were men and just three were women.

From the aforementioned elements, two points could actually surprise the contemporary reader. The first is, of course, the crushing male dominance. The second, equally impressive, point is the fact that not even one patient was clearly categorized as epileptic; that is, the seizures of these twenty-three epileptic patients were described as complementary to some other psychiatric disorder (madness, mania, delirium, etc.) or as symptoms of a disease. As these elements were quite sporadic and did actually cover a short period of time, it would be rather risky to attempt to draw any definite or explicit conclusions, especially, from a purely medical point of view. However, we could suppose that, in contrast to the public character of the National Hospital, the private character of this asylum constituted a possible explanation for these divergences. For, on the one hand, regarding the male domination, there would be a very few rich and upper class families – as these were, as a rule, the inmates of private institutions – who would spend their money and, at the same time, would risk the possibility of a wealthy marriage, by promulgating their daughters’ suffering from epileptic seizures and by confining them within an asylum. Besides, it was possible that their full treatment did not constitute an urgent or exigent issue, since neither their workforce was necessary for the well-being of their family, nor their disease was threatening their family’s name, reputation and honour. Without doubt, they definitely had the money to hire a famous private doctor for domiciliary visit, examination and treatment. On the other hand, regarding the specific nosological categories, we should stress that the patients’ medical files, even if they were really detailed and descriptive, following, to a great extent, the pattern and structure that we met at the National Hospital’s records, did not abound in strictly “scientific”, medical/neurological terms. On the contrary, they mainly focused on the description of the patients’ general condition and their daily progress within the institution. After all, we could maintain that the asylum’s private character and specific orientation, in combination with the patients’ social status, which is going to be analysed in detail in the following sections, did, to an extent, determine the ways of recording and the focusing on specific data.

From this perspective, it is worth juxtaposing the above points with the medical files of the second institution that was examined; the Holloway Sanatorium.⁵ The Holloway Sanatorium Hospital for the Insane, which was located in Surrey, was founded by the philanthropist Thomas Holloway (1800–1883) in 1885. It was also a private asylum that was addressing to patients from the middle and upper social classes. On the whole, there were examined three case-books: (i) the first referred to male “voluntary patients” at the Holloway Sanatorium between June 1891 and March 1897, recording one hundred and sixty-eight cases; (ii) the second referred to female patients who had entered the institution between July 1890 and June 1891, recording eighty-three cases; (iii) the third referred to women who entered the asylum between August 1885 and December 1887, recording only twenty-five cases. From these 276 cases, only eight patients were categorized as “epileptic”, or as suffering from “epileptic fits”, or “epileptiform attacks”, or “epileptiform seizures”. From these eight patients, six were men and two were women – both women were recorded in the second volume that covered the period between July 1890 and June 1891.

As it was the case with the Manor House Asylum, the Holloway Sanatorium pre- sents also some points that do actually surprise the contemporary reader, as well. First of all, let us underline the fact that the relative preponderance of male over female epileptic patients is with no special importance, as it was an extremely small and fragmentary sample. Besides, the most remarkable fact was that just 2.8 % of the total number of patients was categorized as “epileptic” – particularly, 3.5 % of the total number of male patients and 1.8 % of the total number of female patients. At this point, we should keep in mind that, in the case of the National Hospital, epileptic patients constituted steadily the overwhelming majority in comparison to those suffering from other neurological disorders. From this perspective, could we attribute this peculiarity to the private character of the institution, as it was also the case with the Manor House Asylum? All in all, should we attribute this peculiarity to the significant difference between a neurological hospital, with a strict orientation towards the neurological research and treatment of acute and non-chronic cases, and a private asylum, which was mainly focusing on chronic and incurable, mental and neurological disorders?

Regarding the age of the epileptic patients treated by Jackson, during the period 1870–1895, the following overall figures show up: in a total of 368 epileptic patients – in three cases, the patient’s age was not stated – fifty patients were up to ten years old, one hundred and eighty-one epileptics were between eleven and twenty years old, ninety-six between twenty-one and thirty, twenty-one between thirty-one and forty, thirteen between forty-one and fifty, and seven patients were over fifty years old [Table 4.​2]. Without doubt, the most impressive element is the extremely high percentage of young people, aged between eleven and thirty years old, who were suffering from epilepsy or any type of epileptic seizures. At this point, it should be stressed that this prevalence was not to be found only in cases of idiopathic epilepsy – which are more common among children and adolescents – but also in cases, for example, of traumatic epilepsy, namely, one of the most common types of epilepsy in adults. Particularly, about 75.2 % of the patients suffering from traumatic epilepsy were between eleven and thirty years old, while just 11 % was over thirty years old and about 13.5 % were children under ten years old. The same preponderance of the youth results, if we proceed to a diachronic examination and comparison, as it became quite evident in the third chapter. So, given these data, what exactly could this crushing preponderance of young people over the total number of National Hospital’s epileptic patients actually reveal us?

It would be useful to examine some indicative articles published in nineteenth-century medical journals, in order to explore the general trends in the dominant neurological research and discourse. First, it is worth mentioning that we come across an analogous, to an extent, preeminence of young people. A quite indicative example constitutes E.H. Sieveking’s research – thereafter, a physician at the National Hospital. In one of his first articles published in the Lancet, Sieveking analysed fifty-two cases of epilepsy, treated in 1857 (Sieveking 1857). He reported that 69.23 % of the total number of the patients was under twenty years old, while just 30.76 % – that is, less than a half of young epileptics – was between twenty-one and fifty years old. In the same volume of the Lancet, Dr. O’Connor, physician at the Royal Free Hospital, cited the cases of three epileptic women and attempted to correlate their suffering from epilepsy with the symptoms of “amenorrhoea and vicarious menstruation”; all three women were under thirty years old (O’Connor 1857: 525). Respectively, two decades later, in another article published in the Lancet in June 1878, William Gowers attempted to present arsenic as the most suitable treatment towards bromide rash; for this purpose, he focused on twelve of his patients at the National Hospital. From these twelve patients, nine were children and young people under thirty years old, and just three were between thirty-one and fifty years old (Gowers 1878). Moreover, far enough from the city of London, Dr. J. Russell, physician at the Birmingham General Hospital, referred to a total of sixteen epileptic patients, hospitalized in 1859; 66.6 % were between eleven and twenty years old, 26.6 % between twenty-one and thirty, and just 6.6 % were between forty-one and fifty, while age was not stated in only one case (Russell 1859a, b, c).

If we want to thoroughly understand and interpret this dynamic intrusion of young people into the forefront of medical knowledge and treatment, we should, at first, turn our attention to the past; more specifically, to the sixteenth century. Before the advent of Protestantism, English society had been a purely “gerontocratic” society; in other words, it was a society where the youth did not have any kind of power and the elderly – namely, those who supposedly had the necessary wisdom and the required authority – did, in fact, dominate (Bridgen 1997). From this perspective, one of the several consequences of the religious Reformation in England was this particular reversal and subversion of the power relations between the young and the elderly. One of the most serious risks that the Protestantism’s adversaries were afraid of was that the abandonment of the Catholic doctrine would induce young people’s liberation from the spiritual guidance of the elderly, with potentially devastating consequences for the latter’s authority. For, the comparatively more “liberal” culture of the Protestant doctrine and the novel potentials for access to, and interpretation of, the Holy Scripture it offered to the masses, were essentially the first and most important step towards an end-on assault against the clergy’s paternalistic authority and, consequently, towards the challenge of the established power relations, such as those between parents and children. Of course, these fears were considerably reinforced by the apparently radical, Puritan propositions and practices. For, it was the Puritans who attempted to dissolve the clerical guidance of the believers and transform the Bible into the only one Truth that all believers had now the right not only to touch, but also to capture (Durston and Eales 1996).

Moreover, the above fears were also reinforced by the recurrent incidents of supposed demonic possessions of children and young persons. In these episodes, supposedly “possessed” persons were viewed and treated as either demonic/epileptic boys, or demonic/hysteric girls. Through beautifully stylized and standardized plays, through “theatrical”, to a great extent, performances, these young persons proceeded to subversive and quite revolutionary actions – especially, if we take into account the specific historical conditions (Sharpe 1996). For, within the context of these “demonic possessions”, it was rather common for young persons to discountenance and mock the established religion and its earthly representatives, to blaspheme against God, as well as to be disobedient towards any kind of authority – among others, the authority of their parents, the elderly, the representatives of political and judicial power – without facing the slightest repercussion and punishment, due to their “peculiar”, naturally or supernaturally caused, condition.⁶ From this perspective, since it was this generation of young people who, from the seventeenth century onwards, had taken or, at least, attempted to gradually take and retain the wheel within society and who was trying to force the elderly to the margins, why should actually surprise us this huge interest in the preservation of its health and the improvement of its quality of life?

Accordingly, the specific historical context and historical necessities of the advent of the Industrial Revolution and the consolidation of the nineteenth-century industrial state had been the next step that led to this preeminence of young people. The emergence of the capitalist society and metropolis, as it was the case with London, had as a direct and, probably, expected outcome the relocation of young people into the center of systematic, scientific attention. For, young people were now being transformed into the main providers of workforce and, consequently, profit and power to their bourgeois employers. The introduction, which had already begun, quite sporadically, in the early modern period, and consolidation of machines in the production process had as a result the dynamic appearance in the labour forefront of all members of the labour family. As Thomas de Quincey underlined in The Logic of Political Economy (1844), “with the continuous substitution of women’s labour for men’s labour, and, especially, with the substitution of children’s labour for adults’ labour, the number of labourers had considerably increased” (Marx 1982: 410–411, fn. 121). This continuously growing need for healthy and robust labour hands did actually lead to a continuously more intense preoccupation with the human body and, after all, to the gradual medicalization of Victorian health, illness and life. As Weber reminds us, “the capitalism of to-day, which has come to dominate economic life, educates and selects the economic subjects which it needs through a process of economic survival of the fittest” (Weber 1992: 20). Nonetheless, despite the universal character of this phenomenon in western societies, young people have been those who became the first target of this new form of systematic control, discipline and normalization. After all, could we possibly assume that there were the elderly and their “neglected”, “pathological”, ill bodies that were being transformed into one of the first objects of exclusion, isolation and marginalisation within the networks of the novel bio-power that was dominating in the newly-founded capitalist society, during the nineteenth century? To this crucial question, we are going to return in the next chapter.

To conclude our analysis of epileptic patients’ age at the National Hospital, we should definitely turn our attention to the data from the two private institutions that were examined. Concerning the Manor House Asylum, in a total of twenty-three epileptic patients, no patient was under ten years old, whereas three epileptic patients were between eleven and twenty years old, five between twenty-one and thirty years old, six between thirty-one and forty, seven between forty-one and fifty, and two epileptic patients were over fifty years old. So, we can note that, contrary to the National Hospital’s records, just 35 % of the asylum’s epileptics were young people under thirty years old, while the rest, rather high percentage of 65 % were patients over thirty years old. Accordingly, in a total of eight epileptic patients at the Holloway Sanatorium, just one patient was under twenty years old, two patients were between twenty-one and thirty, one between forty-one and fifty, and two were over fifty years old, while, in two cases, the age was not stated; that is, 50 % were young people under thirty and 50 % were over forty years old. Of course, the above data were fragmentary and could, by no means, provide us a clear representation of the actual situation in these two private institutions; nonetheless, we could proceed to some speculative observations.

Once again, the private character of these institutions could, to an extent, explain the relative preeminence of the elderly. In all probability, it was the richer upper class families who would, maybe, have wished to conceal their younger members’ suffering, in order to retain their good fame, as well as the possibility of a wealthy marriage for their daughters. Besides, it was only these families who could have the possibility to hire a private doctor for domiciliary visit and treatment; so, they could ensure a higher degree of anonymity. Furthermore, it was only upper class families who could have spent money for the treatment or, more correctly, for the institutional confinement and isolation of their elderly, epileptic relatives; besides, their full recovery was, to a great extent, a “midsummer night’s dream”, given the nineteenth-century doctors’ prognostic and therapeutic pessimism regarding epilepsy. For this reason, along with their general scientific orientation, public hospitals tended, in general, to reject incurable and chronic cases – as it was the case with the elderly – from which private institutions used to profiteer. Once again, there are emerging the strict demarcation lines between a public/charitable and a private institution, and, more importantly, between a neurological hospital and a mental asylum.

In reference to the marital status of John Hughlings Jackson’s epileptic patients, extremely impressive is, at first sight, the fact that in a total of 371 cases, marital status was not stated in 214 – more specifically, in the case of one hundred and twelve men, and one hundred and two women. From the remaining 157 patients, one hundred and fourteen were recorded as single (forty-seven men and sixty-seven women), forty as married (twenty-five men and fifteen women), and three as widows/ers (two men and one woman) [Table 4.​3]. As we presented with great detail in the previous chapter, the same elements are emerging through a diachronic comparison.

Without doubt, two are the most impressive points. The first is the fact that epileptics’ marital status was not stated in about 60 % of the total number of cases; the second is the crushing preponderance of those recorded as single over those recorded as married. Regarding the first issue, it could be partly explained, especially concerning the first years under examination – for instance, epileptics’ marital status was not stated in none of the eighteen recorded cases hospitalized in 1886. For, as one might have expected and as we also noticed through the examination of hemiplegic patients’ marital status, the whole procedure of the recording of the patients and their personal details was still embryonic, during the first years of the hospital’s functioning; this fact was also apparent in the deficient, non-systematized recording and categorization of other data, such as epileptics’ occupation and address of residence. For this reason, the percentage of the cases where the marital status was not stated did actually present a steadily decreasing course; that is, from 89.4 % of the total number of epileptics during the period 1880–1885, it reached 60.5 % during the period 1886–1890 and almost 33.6 % during the years 1891–1895. Moreover, it is worth mentioning that, as the years were passing by and the recording of the patients’ personal details was becoming more standardized, it was principally the case of children and adolescents under sixteen years old, for whom the marital status was not stated. Especially, from 1889 onwards, the marital status was only stated in cases where the patients were over sixteen years old. For example, during the period 1891–1895, there were only four cases, where there was no reference to the patient’s marital status; however, the three of them were seventeen years old and the other was eighteen years old. So, could we actually assume that the patients over sixteen years old, for whom there was no reference to their marital status, were indeed single? For example, quite illustrative was the case of the twenty-eight-year-old G.E., who was hospitalized in 1887 and who was suffering from epilepsy accompanied by post-epileptic mania for fourteen years; there was no special reference as to whether he was married or single (Jackson 1887: 231–243). Could we actually assume that he was single due to the particularly severe condition of his health and that this was probably the reason why the doctors did not clarify it? Accordingly, could also the twenty-two-year-old W.S., who was suffering from epilepsy for seven years, had left school as he “could not learn anything” and was described as “very weak-minded” (Jackson 1887: 719–731), be considered as single, even though his marital status was not also clarified?

On the other hand, it would be rather risky to assume that the only steady elements about epileptics’ marital status are to be found in the years from 1889 onwards, that is, in the years when this personal detail was not recorded mainly in cases of children and teenagers under sixteen years old – as they were ipso facto considered as single. Besides, during the period under examination, men and women in western societies used to get married, in a relatively late age – around their early thirties (Hobsbawm 1989). Additionally, during the years 1891–1895, contrary to the two previous subperiods, there was noted a rather significant differentiation. More specifically, during the period 1886–1890, the number of single patients was almost threefold than the number of married patients, while, during the last period 1891–1895, the number of single patients was almost quadruple than the number of married patients. Moreover, the number of single epileptic patients, during this last subperiod, was one and a half higher than the number of single epileptic patients, during the previous subperiod – namely, sixty-three out of one hundred and twenty-two patients compared to forty out of one hundred and thirty-seven patients, during the years 1886–1890. So, what exactly could we deduce from the aforementioned data? How can we describe mid-nineteenth-century society’s attitudes towards epileptics? Did epileptic patients have the possibility of a normal socialization, integration and acceptance, within the frame of late Victorian society, or were they, in fact, marginalized, stigmatized and excluded? Did the creation of family and the child-bearing constitute some of their major priorities and targets, or did they not even dare to dream of them?

Before trying to answer these questions, it should be stressed that there were only but a few references to epileptics’ marital status in nineteenth-century medical articles. An exception was A. Hughes Bennett who referred in his study to a total of one hundred epileptic patients, of whom 41.5 % were married and 58.5 % were single (Bennett 1884). However, this apparent lack of references could, maybe, be attributed to the significant number of treatises on epileptics’ marriage and, especially, on the potential marriage between two epileptics. An illustrative example is E.H. Sieveking’s treatise On Epilepsy and Epileptiform Seizures. Their Causes, Pathology, and Treatment (1861). In his book, the famous physician at the National Hospital underlined that “this sufficiently demonstrate the truth of the general law that marriage is not curative in epilepsy. […] when there is epilepsy on both sides, I hold that the Legislature ought to intervene to prevent the misery which must follow. […] I would only put a qualified veto upon the marriage of epileptics” (Sieveking 1861: 139–140). Then, he cited the copy of the certificate he had given to a young gentleman, twenty-one years old, who was suffering from epileptic seizures for about fifteen years; the health certificate would enable him to get married.

Of course, similar references were not restricted to the milieu of the city of London and the English countryside, but were actually extended to the other side of the Atlantic, as well. An illustrative example was the case of Minnesota, where, during the ‘National Conference of Charities and Correction’, within the context of the growing concern for weak-minded persons and people suffering from mental and psychic disorders, it was underlined that “[o]ne of the first and most important measures we must advocate would be such a framing of the laws governing marriage in our several States as would make marriage of an epileptic a crime” (Knight 1886: 12). Even in Grahamstown, the remote British colony in South Africa, the British doctor T.D. Greenlees, at the beginning of the twentieth century, claimed that the question of marriage for people suffering from mental diseases – among them, he explicitly categorized epileptics – was gradually receiving, due to the advance of education and civilization, more attention. In his treatise, he concluded that “[w]e trust the time is not far distant when no marriage will be considered lawful without a clean bill of health on both sides, and the minister or magistrate, who marries ‘uncertified’ couples, dealt with as a criminal”(Greenlees 1903: 123).

On the other hand, if we proceed to a comparative juxtaposition of these elements with the medical files of the two private institutions, the results are once again considerably different. Regarding the Manor House Asylum, in a total of twenty three epileptic patients, the marital status was not stated in only two male patients – the one was a child of five years old and the other an old man who was eighty-four years old. From the remaining twenty one patients, thirteen were married (eleven men and two women), seven were single (six men and one woman) and one man was a widower. Concerning the Holloway Sanatorium, there was a relative balance; two patients were married (one man and one woman) and two single (one man and one woman), while the marital status was not stated in four male patients – in two of them, the age was also not stated.

Without doubt, the data, not only in the case of the National Hospital, but also in the case of the two private asylums, were rather fragmentary. Nonetheless, the high percentage of single epileptic patients – especially, as it has emerged through the analysis of the data of the only “public” institution – did not contradict the general percentage of celibacy among British people. More particularly, during the last quarter of the nineteenth century, the percentage of married people was steadily declining; this decline had already begun, in late Georgian period, and had reached its peak, as the British society was moving towards the twentieth century (Woods 1992). Within the frame of the so-called “demographic transition”, whose main feature was the decline in both marriages and births, the major factors for this change were, among other things, the total transformation of the working conditions and the metamorphosis of the family structure, as well as of the role and values of women, through the emancipation movement (Fuchs 2005; Hobsbawm 1989; Holton 1990).⁷

Nonetheless, what the above elements do, to a great extent, demonstrate, is the very significant differentiation concerning the chances of socialization and rehabilitation between epileptic patients from the upper/middle social classes and epileptic patients from the working classes; that is, between patients hospitalized in private asylums and patients hospitalized in public hospitals and institutions. It was, by no means, accidental that the majority of epileptic patients in the two private institutions had succeeded in leading a more “normal” personal life; namely, getting married and having children. On the contrary, it should not surprise us the high percentage of celibacy among the National Hospital’s patients; that is, among the patients of a public/charitable institution, belonging to the lower social classes. Especially, in cases where the patients were suffering from seizures for a long period of time, or where their seizures were quite severe, celibacy was, probably, the only possible prospect.

However, it should be underlined that, in many cases, patients were not influenced by their doctors’ advices and propositions. For, there were many doctors, who not only suggested and, very often, dictated the avoidance of epileptics’ marriage, but also advised their patients to examine the existence of severe diseases in the family history of their future spouses in order to avoid a potential marriage (Waller 2001). These proposals reflected the emergent theory of degeneration, as it was formulated in the mid-nineteenth-century medical discourse, highly influenced by eighteenth- and nineteenth-century zoology and evolutionary biology. At this point, we should note that one can actually find the first nuggets of pro-Darwinian ideas regarding the human nature and its evolution throughout history, already, in early nineteenth-century scholars’ writings. One of the most representative examples was the case of the British surgeon Sir William Lawrence (1783–1867), who, in his rather provoking Lectures, published in 1822, was asserting that “a superior breed of human beings could be produced only by selection and exclusions similar to those so successfully employed in rearing our more valuable domestic animals. Yet, in the human species, where the object is of such consequence, the principle is almost entirely overlooked. […] Hence all the native deformities of mind and body […] are handed down to posterity […] and degrade the race” (Lawrence 1822: 397). Of course, it might have been that he was forced to withdraw the second of his series due to the severe criticism it provoked⁸; however, his ideas were indicative of a more general trend, which would culminate in the decades that followed the mid-nineteenth century. Without doubt, it was the Darwinian work that gave the final and strongest impetus.

In the field of psychiatry, quite illustrative was the work of the French psychiatrist Bénédict-Augustin Morel (1809–1873), who in his Traité de la dégénérescence (1857) regarded degeneration as the morbid deviation from an archetypal type of man (Lekka 2012). This particular deviation was attributed to the so-called “hereditary transmission” (“transmission héréditaire”). Morel described the common evolution of degeneration that could begin from the appearance of a slight nervous disposal, proceed to a series of brain and mental disorders (epilepsy, hysteria, etc.) and end up in the offspring’s incurable, physical and mental degeneration. For him, degenerate people were a potential threat and danger not only to themselves and their family, but to the whole social body.⁹ Morel’s influence was quite apparent, among others, in the work of the French psychiatrist Jacques-Joseph Valentin Magnan (1835–1916), the German psychiatrist Richard von Krafft-Ebing (1845–1902), the English psychiatrist Henry Maudsley (1835–1918) and the Italian criminologist and psychiatrist Ezecchia-Marco (‘Cesare’) Lombroso (1836–1909). In fact, as we are going to see in the next chapter, the theory of degeneration would dominate in late nineteenth-century and early twentieth-century medical discourse.

Nonetheless, these theories had not yet rooted in the virgin soil of the English society, while the medicalization of life and death was still embryonic, and could not defend and justify such prejudices and trends towards epileptics’ marginalisation. The majority of the Victorians, especially from the working classes, did not choose their future partner according to his/her medical history and health certificates. A palpable evidence was, maybe, the fact that most epileptics who were married had also many offspring; actually, a very few of them had remained heirless. Quite illustrative was the case of the thirty-year-old E.R., hospitalized in 1888, who was married and had already given birth to five healthy children (Jackson 1888: 369a–378a), as well as the case of the thirty-year-old L.J.H. who has given birth to nine children (Jackson 1887: 163a–171a), whereas in the case of the twenty-eight-year-old C.H., hospitalized in 1890, who was suffering from epilepsy and dementia for fourteen years, it was highlighted that she was happily married to a baker (Jackson 1890: 235a–250a). Of course, the remarkably higher number of single epileptic women to single epileptic men could be attributed, to an extent, to the proliferation of voices, within the discussion of the so-called “national degeneration”, that strived for the vigour and perpetuation of the English nation, through the birth and breeding of healthy children; according to the basic lines of the degeneration theory, an epileptic mother could hardly provide them. However, most people were much more influenced by the economic status of their future partner and the possibility of finding a decent occupation, either when they were patients themselves, or when they chose to marry someone who was a patient (Waller 2001). In a rapidly changing, capitalist economy, social and economic criteria were obviously dominating, constituting the major concern and the basic guidelines for people’s life choices. Keeping this observation in mind, we should move on to the next, directly connected, category under examination.

The next category is epileptic patients’ occupation, during the period 1870–1895. However, it would be necessary to begin with some introductory remarks. First of all, in order to be able to categorize and classify John Hughlings Jackson’s epileptic patients into the various social and economic groups within Victorian society, it would be necessary to examine briefly the limits and functions of the concept of “class”. For social and economic historians, the concept and category of class has functioned as another, very useful and convenient, analytic and hermeneutic, theoretical tool; namely, “‘class’, […], lends itself admirably to generalization; if it suits no one occasion particularly well, it suits them all tolerably well. Or, at least, most historians seem to think” (Himmelfarb 1971: 167). Within the frame of the various national histories, this trend has found, from time to time, an ideal way of expression through the attempts to analyze and interpret the British social history. It is for this reason that, as it has been emphatically underlined by David Cannadine, “rather than employ class to explain history, it now seems that we should employ history to explain class” (Cannadine 1998: 15). However, this great, to an extent, convenience in using this concept and the concomitant oversimplifications should actually draw our attention to the particularities of the English society and the Victorian era, in particular.

During the second half of the nineteenth century, within the rapidly transforming, industrialized English society, the intense social mobility, the decay of the traditional hierarchies and the simultaneous maintenance of the three basic models of society’s viewing, understanding and analysis (hierarchical, triadic, dichotomous) had rendered the demarcation lines and limits among the various social groups extremely indiscernible and fragile.¹⁰ Without doubt, this problem did not concern only the narrow frame of the emergent middle class, in which this situation was particularly intense due to the continuously growing number of people who invaded its boundaries. There were equally no discrete limits between the middle and the lower social classes, as well as between the working classes and the so-called “dangerous classes” – that is, between what has been called “proletariat” and “lumpenproletariat”.¹¹ Due to the great range of occupations, the several levels of skills, the various types of employment and the numerous locations of work, “there was no more a homogeneous proletariat than there was a homogeneous bourgeoisie or aristocracy” (Cannadine 1998: 91–92). Besides, social structure and stratification were so complicated phenomena that could not be subsumed under similar simplifications. Consequently, the search for identifiable criteria and the adoption of different cultural patterns and behaviours became a rather imperative need for all social classes, during the last quarter of the nineteenth century (Hobsbawm 1989; Jones 1983; Cannadine 1998).¹²

Nonetheless, the above observations do, by no means, imply the denial of the existence of, at least, some social, economic and cultural demarcation lines in late Victorian society. The aim of the aforementioned remarks has been just to indicate and justify the adoption of an entirely schematic and, to an extent, arbitrary class and social differentiation of the National Hospital’s epileptic patients. By taking into account some generally accepted categorizations and by using the, probably arbitrary but quite convenient, tripartite distinction between upper, middle and lower (working) social classes, we are going to try to classify epileptics in these categories; for a more accurate categorization, we are going to add the special, separate categories of women who were occupied with household duties, of school pupils, of students and, of course, of unemployed people.¹³ Besides, nineteenth-century chronicles and texts have constituted a quite valuable tool in our classification of the diverse professionals into the various social groups. For example, in the “respectable” working classes were included, among others, “skilled artisans, policemen, and firemen, railway engineers or gaffers in the gasworks”, and in the more skilled workers were included “tailors, shoemakers, hatters, cabinet-makers, toymakers, turners, carpenters, coopers, joiners, sawyers, shipbuilders, and weavers”, while in the “labouring poor” were classified “the dock and wharf labourers, the porter and the costermonger” (Porter 1994: 282, 347, 280). On the other hand, concerning women’s employment, five were the main sectors, which had already been in existence during the early modern period: (i) household labour, (ii) child care, (iii) food distribution and retail, (iv) manufacturing and (v) prostitution; the first category outnumbered the other four. Within this frame, by taking into account both the short description of the ‘National Society for the Employment of Epileptics’ and our reference to the significance of the notion of professional calling in the building and consolidation of the capitalist economy and industrial society, as well as the differentiation between public and private institutions, it becomes quite obvious that epileptics’ occupation emerges as a distinctly important issue.¹⁴ From this perspective, its presentation and analysis is going to enable us to reconstruct and represent the position and status of epileptic patients, in Victorian England.

First of all, we should underline the fact that, during the period 1870–1895, occupation was not stated in 184 in a total of 371 epileptic patients at the National Hospital – namely, almost in half of them – while, in three cases, it was impossible to decipher the handwriting. From the remaining 184 cases, no patient belonged to the upper social classes, twenty-two epileptic patients belonged to the middle social classes (among others, clerks, teachers, shopkeepers, etc.) and one hundred and twenty-two belonged to the lower social classes (mainly, labourers, domestic servants, laundresses, craftsmen, drivers, gardeners, assistants, etc.). Moreover, four women were occupied themselves with household duties, thirteen children were still going to school and one young man was a dental pupil, whereas twenty-two epileptic patients were unemployed [Table 4.​4]. So, almost 66.3 % of the total number of Jackson’s epileptic patients belonged to the working classes, 11.9 % belonged to the middle social classes, while a further 11.9 % was unemployed. As we ascertained in the third chapter through a more minutely recording of each epileptic patient’s occupation, the same results are emerging through a diachronic comparison of these elements; namely, the preponderance of those belonging to the lower social classes. Without doubt, several questions arise from these data.

First of all, it is worth noting that epileptics’ occupation – as it was exactly the case with their marital status – was not stated in half of the National Hospital’s cases. Of course, concerning the first years under study, the recording and categorization was still in an embryonic form; this had as a result the omission, or even neglect, of many personal details. The degree of the rigorous observation that was to be found in the medical files and the concomitant objectification of the patients had not reached yet the depth and completeness of the following years. The relatively fragmentary character of the patients’ medical files, should be, probably, attributed to the fact that the new forms of systematic medical surveillance, clinical observation and neurological knowledge, as well as of social control and “rehabilitation”, were just beginning to consolidate within the mid-nineteenth-century medical discourse. For this reason, the percentages of the cases, in which epileptics’ profession was not recorded, were gradually declining; namely, from 63.8 % during the first subperiod, to 57.9 % during the next subperiod and to a further 31.9 % during the last period under examination. Additionally, we should also highlight the fact that, especially during the last years under study, occupation was not stated in, mainly, two categories; on the one hand, in the case of children and young persons, roughly under twenty years old, and, on the other hand, in the case of women.