According to A.H. Bennett, “[t]he 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 arts” (Bennett 1884a: 5; emphasis added). Within this frame, “[e]pilepsy, like all other chronic diseases, presents great difficulties in scientifically estimating the exact value of any particular remedy; and unless the investigation is approached with the strictest impartiality, and observations made with rigid accuracy, we are liable to fall into the most misleading fallacies” (Bennett 1884b: 18; emphasis added).

In the above abstracts, published in the British Medical Journal in 1879 and in the Edinburgh Medical Journal in 1881 respectively, the doctor A.H. Bennett examined some aspects of both epilepsy’s etiology and symptomatology, and potassium bromide’s action. As it became quite obvious, a special emphasis was put on the significance of accuracy and objectivity in scientific research. For, the target was always the production of “valid”, “scientific” knowledge and the extraction of definite and crystal-clear “scientific” conclusions. His observations, accompanied by statistics and several tables, were indicative of this new trend, particularly dominant within Victorian medical circles; that is, the turn towards a clearly scientific explanation and treatment of all physical and mental disorders, in general, and towards a purely “neurological” approach and interpretation of epilepsy, in particular. To fully understand the innovative character of this turn, we should keep in mind that epilepsy was going hand in hand, until the end of the seventeenth and the beginning of the eighteenth centuries, with demonic possession and exorcism, while, until the beginning of the nineteenth century, it was identified and confined in the same loci with madness.

From this perspective, the aim of this chapter, namely, of the “epistemological” part of our analysis, is the examination of epilepsy’s emergence as a purely neurological disorder and of the multilevel ramifications of this major rupture. Half a century after psychiatry’s emergence as a distinct scientific field and within the context of the widespread specialization in medicine, neurology consolidated as a distinct scientific field and as a discrete medical specialty. Through neurology’s emergence, through a series of new and more accurate methods of scientific observation and recording, through the systematic forms of medical examination and categorization, epilepsy and, consequently, the human brain became one of the primary objects of neurological knowledge and discourse. So, having once again as our guide the National Hospital’s medical files, we are going to “regard illness as a text or story which requires interpretative skills, because illness rather like a novel suggests multiple or indeed infinite interpretations all of which may be plausible” (Turner 1995: 205); in other words, we are going to try to read and decode epilepsy’s neurological text.

To begin with, we are going to focus on these elements that will allow us to approach the new scientific and, in particular, neurological dimension of epilepsy, in late Victorian England. From this perspective, the following elements will be analysed and evaluated: the time between the first manifestation of the disease and the patients’ admission to the National Hospital, the length of the patients’ hospitalization, the prescribed treatment, the result of their hospitalization and, finally, the ways in which mid-nineteenth-century doctors used to represent and reconstruct epilepsy, epileptic seizures and epileptic patients’ condition, through the detailed and elaborate analysis of the medical files of John Hughlings Jackson’s 371 epileptic inpatients.

Regarding the time between the appearance of the first symptoms of the disease and the patients’ admission to the hospital, during the period 1870–1895, the following can be noted: on the whole, the time period was not stated only in nineteen cases; from the remaining 352 cases, five patients had presented the first symptoms of their disease for a period less than thirty days before being admitted to the National Hospital for hospitalization, forty-nine for a period between one and six months, twenty-six for a period between seven and twelve months, one hundred and sixty-two patients were suffering from seizures for a period between one and five years before their admission, sixty for a period between six and ten years, forty-one for a period between eleven and twenty years, while nine patients were ill for more than twenty years before deciding to go to the hospital for treatment [Table 5.​1]. From the aforementioned, one can easily notice that the overwhelming majority of Jackson’s epileptic patients were suffering from seizures for a rather long period of time, before resorting to the medical authority for relief and salvation from their bodily and definitely psychic dolour. So, an impressively – according to modern scientific criteria – high percentage, namely, 63.1 %, was ill for a period between one and ten years before being admitted to the hospital, while another 14.2 % was suffering from epileptic seizures for more than eleven years; on the whole, 77.3 % of the patients was living its daily round along with the reality of epilepsy as its companion for several years. On the other hand, equally impressive was the extremely low percentage, about 1.4 %, of the patients who were ill for less than thirty days before being admitted for medical treatment.

From this perspective, in order to inscribe the National Hospital’s medical files within the current neurological discourse, it would be useful to examine the relevant data in mid-nineteenth-century medical journals that presented many cases of epileptic patients hospitalized in several English hospitals and institutions – basically, in London. Two crucial points are emerging that should be highlighted, as they reinforce the above remarks. Firstly, there were many cases, where the time between the first manifestation of the disease and the patients’ admission to the hospital was not recorded – quite possibly, because it would have been self-evidently long. Quite illustrative were the ‘Gulstonian Lectures on Epilepsy’, where William Gowers was analyzing 1,450 cases with great detail and perfectly scientific terminology and method. Nonetheless, he did not think of it as necessary to refer to the time period, during which his patients were suffering from seizures before going to advise him (Gowers 1880a). Secondly, in most cases where the time was actually stated, mainly, in regard to the cause of the first seizure and the specific symptoms of the disease, this time period was especially long. For example, in the review of a number of cases at St. George’s Hospital published in the British Medical Journal, a thirty-year-old man was suffering from “fits for seven years” and a foreman was having “attacks for fourteen months” (Anonymous 1857: 541–542). Accordingly, a fourteen-year-old girl, who was admitted to the Westminster Hospital as an outpatient, was suffering from seizures for about seven years; “these fits varied in intensity, in frequency, and in the time of their occurrence. At times she had nine or ten daily, and at other times would be free for two months” (Hebbert 1883: 708–709). In other words, it was a case of a severe form of epilepsy. Moreover, Dr. M. Anderson, professor at the University of Glasgow, noted that the seizures of hystero-epilepsy of an eighteen-year-old domestic servant began three years before her admission to the Glasgow Western Infirmary, “when she had an attack of typhus fever” (Anderson 1879: 41–42). So, what kind of conclusions could be inferred from the aforementioned elements?

It would be necessary to take into consideration three important parameters. First of all, we should draw our attention to the generally paroxysmal character of the disease. Epilepsy is still defined as “a brain disorder involving repeated spontaneous seizures of any kind” (Health Central 2013; emphasis added), and an epileptic seizure as “an uncontrolled synchronized paroxysmal discharge of neurons in the brain” (Solomon et al. 1983: 19; emphasis added). In other words, someone can suffer from an epileptic seizure sometime in his/her lifetime and, then, be free of seizures for a long period of time – sometimes, even for the rest of his/her life. At the same time, the frequency and character of the seizures cannot be predicted with accuracy. According to the findings of twentieth-century neuroepidemiology, 0.5–1 % of the world’s population is having active epilepsy, with slight variations according to the country under study¹; with the term “active epilepsy”, we refer to those people who are fulfilling the scientific criteria for epilepsy and who have had at least one epileptic seizure during the last five years, or they are still being treated with antiepileptic medication (Sridharan 2002; Forsgren 2004). At the same time, there is a further 3–5 % who is going to suffer sometime from a single, unprovoked epileptic seizure. From this percentage, just one out of three patients is going to have a second seizure, within the next five years of his/her life (WHO 2005). After this second seizure, 75 % is going to have a third one, within the next one or two years. Of course, these specific particularities of the disease are taken into consideration by neurologists and neurosurgeons, while simultaneously treating epileptic seizures with pharmaceutical medication. More specifically, a period of two years is normally considered as the necessary period of time, during which a patient must remain free of seizures, in order to withdraw antiepileptic drugs – particularly, two to three years are required in the case of childhood absence seizures and two to five years in any other type of seizures (Solomon et al. 1983). Even in our days, the severity and the course of an epileptic seizure are not evaluated exclusively on the basis of the primary manifestation, and epilepsy is not treated as a definitive fact, with prescribed beginning, evolution and ending. Besides, the distinguishable, incessantly changing character of epilepsy had been already identified by the author of the Hippocratic On the Sacred Disease, who attributed seizures’ appearance and intensity to a variety of factors, such as the patients’ age, the winds and their mental state, underlining that “thus is this disease formed and prevails from those things which enter into and go out of the body, […]” (Hippocrates 1993: §13).² Consequently, mid-nineteenth-century doctors did by no means constitute the exception to the above “rule” of epilepsy’s diagnosis.

The next parameter is directly correlated with epileptic patients’ gender and age. To this direction, quite illustrative are the elements that emerge through the comparative analysis of the subperiod 1886–1890. Concerning the issue of the patients’ gender and the corresponding time of being ill before their admission to the National Hospital, there was noted a relative balance. Let us mention that 45.9 % of Jackson’s male patients were suffering from seizures for a period between one and five years before their admission to the National Hospital; the corresponding percentage for female patients was 44.4 %. On the other hand, the percentage of male patients who were ill for a period between one and twelve months was 14.8 %, while the percentage of female patients was reaching 22.2 %. This slight divergence can be quite easily explained if we take into account that it was men who, as a rule, were taking over the survival of the family and, consequently, those who had as their duty to work at all costs.

Accordingly, in reference to the issue of epileptics’ age, it is noteworthy that, during the period 1886–1890, 45.5 % of children under ten years old were suffering from seizures for a period between one and five years before being hospitalized; the corresponding percentage for teenagers and young people between eleven and twenty years old was about 47.5 %, and for young persons between twenty-one and thirty 45 %. Additionally, the percentage of children under ten years old who were ill for a period between one and six months before their admission was 13.6 %; for teenagers between eleven and twenty years old 13.1 %, and for young people between twenty-one and thirty 5 %. Even though children did not yet constitute the primary focus of medical attention and concern, as it was going to happen at the beginning of the twentieth century, nonetheless, these percentages do actually reveal the gradually growing interest in the condition of children’s and young people’s bodily and mental health, especially, within the frame of the coordinated evaluation and exploitation of young people’s workforce. In this way, age, as well as gender, played a crucial role in the decision about epileptics’ hospitalization.

In direct correlation with the above, the last, extremely important parameter concerns the occupational status of John Hughlings Jackson’s epileptic patients and its connection with both the time period of the appearance of their illness before hospitalization and the frequency of their seizures. Some quite interesting cases of epileptic patients hospitalized during the period 1886–1890 could be cited. For example, the thirty-six-year-old J.J.D. – farm labourer, married and father of four children, hospitalized in 1888 – was suffering from seizures for just twelve months, before deciding to go to the National Hospital for treatment; their frequency varied from one seizure a week to one seizure a fortnight (Jackson 1888a: 223–237). On the other hand, the twenty-two-year-old F.P., also hospitalized in 1888, withstood for twelve whole years. However, his decision could be explained by the fact that, at first, he had only one seizure every six months. On the contrary, during the last six months, the intervals between his fits were shorter, varying from one seizure a week to one seizure a month; it was this sudden change in frequency that would have, in all probability, forced him to speed his hospitalization (Jackson 1888a: 417–428). Accordingly, the nineteen-year-old labourer J.T., hospitalized in 1889, was ill for three years. For, despite the fact that his seizures were increasing in frequency, they took place, mainly, during night; that is, without causing him any particularly obvious problems to his work and daily life (Jackson 1889: 789–800). Respectively, E.M., nineteen years old, also hospitalized in 1889, was suffering from epileptic seizures for three whole years. However, as her seizures occurred every other week or every month, they did not impede her to be devoted to household duties (Jackson 1889: 349a–359a). The same was also happening with the case of C.H., twenty-eight years old, who was ill for fourteen years and was admitted, from time to time, to the National Hospital as an outpatient; nonetheless, the fact that she had suffered from only three seizures in the last seven years could explain both her normal family life and marriage to a baker, as well as the relative delay of her hospitalization in 1890 (Jackson 1890: 235a–250a). Lastly, quite impressive were the following two cases. On the one hand, it was the case of the nineteen-year-old J.B., who was working as an iron dresser and who was suffering from seizures for seven years. At first, he had thirty to forty seizures a day, but lately they were not so many in number; his seizures varied in character, as some were slight and some severe, whereas they were taking place during both night and day (Jackson 1888a: 77–91). In other words, it was a rather severe case of epilepsy; however, he waited for seven years, before seeking for treatment in 1888. On the other hand, it was the case of the twenty-two-year-old bootmaker, W.J.M., who, despite the fact that he had had rather frequent seizures that were lately extending from one to two batches every week, decided to be hospitalized in 1890 after seven whole years; the delay in his hospitalization could be possibly explained by the fact that most seizures were often simple “sensations”, which consisted, in a way, of an instant loss of consciousness, accompanied by the patient’s fall (Jackson 1890: 587–604). After all, which were the implications of these parameters and which were the decisive factors that most influenced nineteenth-century epileptic patients’ decision to seek medical treatment and hospitalization at a neurological hospital?

According to the aforementioned, the supposed dangerousness of just one single epileptic seizure did not constitute a decisive factor in epileptic patients’ decision for hospitalization – even in those rare cases, in which they were, in fact, familiarized with current medical theories. In all likelihood, a distinctly more significant role played their professional, economic and social status. It became rather obvious that in cases where epileptic seizures did not apparently affect the patients’ daily life and work, their disease did not particularly trouble them. Maybe, this was the reason why the equivalent period of time for hemiplegic patients was, as we saw in the third chapter, quite shorter, since the symptoms of hemiplegia were by far more intense and could demonstrably cause insurmountable difficulties in their daily lives. In the rapidly changing and transforming Victorian society, the living conditions of the overwhelming majority of the lower social classes – to which the majority of the National Hospital’s patients belonged – were, without any exaggeration, especially precarious. During the last decades of the nineteenth century and, despite the definite decline in the mortality levels of the English population, the from time to time high unemployment rates and the decline in wages, the increase of criminality and alcoholism, the bulk of slums and the permanent congestion, the consequent poor conditions of health and the imminent danger of epidemic diseases, contributed all to the general bodily and psychic deterioration of a, rather large, group of people.³ So, the need for a regular employment and a regular wage was for most people highly imperative, in order to be able to cope with the above problems and to improve their living conditions. In this way, there took place the – at least, at first sight – following paradox: most patients’ symbiosis with their epileptic seizures would continue as long as their own survival was not directly endangered.

However, beyond – and despite – the definitely economic and social character of the delay, or even postponement, of epileptics’ decision for treatment and hospitalization, it is worth examining quite briefly another, less pronounced aspect of this particular issue; specifically, the degree and intensity of medicalization, within Victorian society. According to Roy Porter, it was Enlightenment that, in a way, “sped the medicalization of life and death” (Porter 1999b: 302). More particularly, the notion and process of medicalization implies the constant and continuously growing expansion of medical power and authority in various aspects and fields of human life and action, as well as the simultaneous transformation of a constellation of non-medical problems and behaviours into purely medical conditions – most usually, in regard to, and in terms of, illnesses and disorders.⁴ For this reason, the key to the process of medicalization is, in essence, the invention and imposition of the corresponding definition; that is, of the transformation of a, so far, “normal” and “physiological” condition into a “pathological” disorder. So, to which extent had been medical power and medical discourse consolidated in late Victorian society?

Broadly speaking, “the Victorians were fascinated by the strange new worlds that science opened to them. […] Victorians of every rank, at many sites, in many ways, defined knowledge, ordered nature, and practiced science” (Lightman 1997: 1). Without doubt, within the frame of this new fashion, we should include their adoration for health and its multilevel aspects and implications. Actually, no issue occupied more people’s minds during the second half of the nineteenth century than health. Their interest in society, politics, religion and culture originated in, and was in direct connection and interrelation with the notion of health; “Victorians worshiped the goddess Hygeia, sought out her laws, and disciplined themselves to obey them” (Haley 1978: 3). For this reason, there was noted during this period a remarkable movement towards the identification, categorization and description of a great variety of diseases and pathological disorders. The imminent danger of illness led Victorians to turn their attention to an agonizing attempt to know and map their bodies, and define the principles that ruled their function; at the same time, they were trying to attach a moral significance to the laws of life (Haley 1978). Rather indicative of this, to an extent, “frenzy” was, for instance, the huge enthusiasm with athletics and sports; “athletics in the modern sense is wholly a product of the middle Victorian decades” (Haley 1978: 129). The occupation with athletics and the continuously growing list of sports verged on the limits of national obsession and were directly connected with the struggle for the ethical and physical reform of the English nation, and, consequently, with the issue of the national degeneration, which dominated the thoughts and actions of a significant group of people in late nineteenth-century English society and to which we are going to return thereafter.

However, at this point, we come upon the following paradox and the contradictory, to an extent, phenomenon, compared to the above descriptions. In nineteenth-century texts, working classes were often characterized as “the Great Unwashed”, since they were being considered as indifferent and ignorant regarding issues of personal hygiene, setting conditions and health conditions, in general (Sigsworth and Worboys 1994). In all likelihood, these accusations, which were, as a rule, coming from the upper and middle social classes, originated in the probably non-existent degree of participation of the lower social classes in the movements of public health reform, especially, from 1848 onwards – that is, when, in fact, the public health reform movement began after the 1848 ‘Public Health Act’, which created the General Board of Health and was followed by a whole range of equivalent and, often, much more specialized acts, as we are going to examine in the next sections (Stratton 1894).⁵ Nonetheless, it should not be omitted that, from time to time, several objections have been raised by scholars, who have underlined the fact that the working classes were actually interested in the condition of their health; they just differed in the way of showing that interest and in the object of their direct interest. For, they were deeply interested in the securing and improvement of their “daily bread”, and in the change of the unhygienic congestion in the slum dwellings where the majority of them was living (Sigsworth and Worboys 1994). Besides, as Foucault has remarked in his analysis on sexuality, the issues of the body, its longevity and its hygiene did, until, at least, the end of the nineteenth century, constitute problems that initially concerned the middle and upper social classes before diffusing to the social body as a whole (Foucault 1998). For, what was actually at stake was not the subjugation of one class (i.e., the working class), but the self-affirmation of another (i.e., the upper classes), through the cultivation of a robust, powerful, healthy body. In other words, the aim was the construction of a body that would be the registered trademark of its dynamic and its domination, and that would lead, through the creation of equally healthy offspring, to its perpetuation; once again, here comes to the fore the vital issue of national degeneration that is going to be examined afterwards.

Thus, it should not surprise us the fact that the National Hospital’s medical files do indeed reinforce, rather than contradict, the above observations. The usually long period during which John Hughlings Jackson’s epileptic patients remained without medical advice and treatment – with the exception of a few who had either already resorted to the National Hospital as outpatients before their admission, or advised some other doctor at another London hospital – was, after all, quite indicative not only of the obstacles that their economic and social status posed them, but, especially, of the negligible authority and power that scientific medicine could so far exert over their body. For, with the exception of the public health reformers and some members of the educated, upper social classes, this obsession with health, which many commentators could detect in Victorian society, was, at first, mainly restricted to issues of better nutrition, as well as personal hygiene and cleanliness. Besides, it was for this reason that the public baths were beginning gradually to emerge in the collective imaginary as the new symbols of the deification of public health (Wohl 1983; Vigarello 1988).

In support of this view, a quick look upon the two private institutions’ medical files suffices. Concerning the Manor House Asylum, out of twenty-three epileptic patients, the time of being ill before their admission was not stated in nineteen cases; from the remaining four cases, two patients were ill for a period between one and six months, one patient for a period between seven and twelve months and one patient for a period between one and five years. Regarding the Holloway Sanatorium, this particular detail was not recorded in three cases, while two patients were ill for a period between one and five years before their admission, one patient for a period between six and ten years, one patient for more than twenty years and for one patient it was stated that he was suffering from seizures “for several years”. Given the fact that many private asylums’ inmates were usually being confined in several institutions, as well as the fact that the vast majority did not face any particular economic problems that could lead to the postponement of their hospitalization or impede them from hiring a private doctor for domiciliary visit, it would be rather risky to attempt to draw any solid conclusions from the above, quite fragmentary elements of these two private institutions, in reference to the degree and intensity of medicalization.

To conclude, it might be that, during the period under examination, diseases and any kind of pathological disorders were regarded and treated by doctors as a rather severe danger and an “abnormal” divergence from the scientifically – as well as socially, politically and culturally – accepted norms, with health being elevated to the absolute ideal and the primary object of scientific knowledge. And, it might also be that the already consolidated capitalist way of production and the notion of the “professional calling”⁶ were crying for the imperative need for healthy, docile and capable of working bodies. Nonetheless, we should keep in mind that it was still an on-going historical process; consequently, late nineteenth-century people could not, in essence, share or hastily adopt these opinions. In direct relation to their social class and economic status, they were just beginning, in a way, to identify their physical and mental health with the homo medicus and the locus of the hospital. The fusillades of the battle that scientific medicine was determined to give, in order to establish its authority, were just beginning to reverberate under the grey sky of late Victorian society.

In reference to the second category under examination, namely, the length of hospitalization of John Hughlings Jackson’s epileptic inpatients, at the National Hospital, during the period 1870–1895, the following should be noted. For an aggregate of 371 patients, the length of stay was not stated in twenty-five cases – namely, in twenty cases hospitalized during the first subperiod (1870–1877, 1879) and in five cases during the second subperiod (1880–1885). From the remaining 346 cases, fifty-eight patients remained at the hospital for less than thirty days, two hundred and seventy-eight patients were hospitalized for a period between one and six months, eight for a period between seven and twelve months, and two patients remained at the hospital for more than a year [Table 5.​2]. So, the overwhelming majority of epileptic patients – particularly, 80.3 % – remained at the National Hospital for a period between one and six months. According to twenty-first-century medical standards, it is a time period that would seem to contemporary readers, in all likelihood, quite extreme.

Respectively, the data to be found in mid-nineteenth-century medical journals and treatises were actually moving towards the same direction. For example, Dr. A. Robertson, physician at the Glasgow Hospital, cited the case of a forty-five-year-old soldier, who was suffering from seizures for five years, at intervals from one month up to six weeks, until the time of his admission to the hospital; he was hospitalized under Robertson’s care for four months (Robertson 1883: 492–494). Equally characteristic was the case of a married woman, twenty-eight years old, who was suffering from hystero-epilepsy and who remained at the Glasgow Western Infirmary for four months, as well (Anderson 1879: 207–208). Accordingly, a young Roman-catholic, twenty-one years old, who was suffering from hystero-epilepsy for about four months, remained at the hospital also for four months (Sansom 1881: 369–370). Furthermore, equally representative was the case of R.R., an engine-driver, thirty-seven years old, whose seizures began quite suddenly, with an average of five per day, and who was hospitalized at the House of Correction, in Bombay, for about two months (Yeates Hunter 1875: 789–790). Finally, rather impressive was the lack of this particular information in the presentation of sixteen patients, hospitalized at the Birmingham General Hospital, whose length of hospitalization was not stated (Russell 1859a, b, c), as well as in the analysis of the 1,450 epileptic patients treated by Gowers, as they were elaborated in his ‘Gulstonian Lectures on Epilepsy’ (Gowers 1880a). According to the above, quite informative data, the length of epileptic patients’ hospitalization appeared – at least, at first sight – rather long. This fact could be explained, if we take into account the recently emergent neurological theories and the concomitant embryonic therapeutic methods. As a result, mid-nineteenth-century doctors did not always have the means to successfully treat their patients and to speed their discharge from the hospital. Besides, the diachronic comparison of the National Hospital’s medical files equally revealed an almost total balance between the various subperiods, which advocates a relatively slow progress in scientific knowledge and in the concomitant technological advances and novelties, and vice versa.

However, if we proceed to a comparison of the above information with the quite fragmentary, but definitely illuminating, data from the two private institutions, then, our evaluation of epileptics’ length of stay at the National Hospital should, probably, be considerably differentiated. Concerning the Manor House Asylum, the length of hospitalization was not recorded in five cases; from the remaining eighteen cases, two patients remained at the asylum for less than thirty days, three for a period between one and six months, five for a period between seven and twelve months, seven were hospitalized for a period between one and five years, and one patient for a period between six and ten years. Regarding the Holloway Sanatorium, patients’ length of stay was not stated in just one case, while two patients remained at the asylum for less than a month, one for a period between one and six months, and four for a period between one and five years. Beyond the considerably longer length of stay at these two asylums – this was not restricted to epileptics, but was also extended to other patients, as well – what was more striking were the specific reasons for the termination of the patients’ hospitalization, especially in cases where they were hospitalized for a rather short period of time. Under these circumstances, it is quite indicative that out of the three epileptics hospitalized at the Manor House Asylum for a period between one and six months, two of them were discharged in order to be transferred to another institution, while the other patient died. Accordingly, in a total of five epileptics hospitalized for a period between seven and twelve months, two of them were transferred to other institutions, two died and the other killed himself – he “jumped out of window”, “killed himself in an epileptic seizure” (Manor House Asylum 1870–1884: case 82). Accordingly, at the Holloway Sanatorium, in regard to the two patients, who remained at the asylum for less than thirty days, the one patient died and the other was removed to Bishopstone House. So, how could be the above data integrated within the specific historical context? What conclusions could be deduced in reference to epileptic patients’ length of hospitalization?

First of all, it should be emphasized that there was an obvious differentiation between a public/charitable and a private institution, and, more significantly, between a neurological hospital, as it was the National Hospital for the Paralysed and Epileptic, and a mental asylum, as it was the case with the Manor House Asylum and the Holloway Sanatorium, in reference to their character, their function and their inmates. On the one hand, public hospitals or any kind of public/charitable institutions were mainly addressing to the poorer and lower social classes, since the hospitalization there was free of charge, or the cost for their medical provisions – in case someone was actually paying for them – was, as a rule, entirely symbolic. Accordingly, the aim of a (neurological) hospital was to attract patients with acute, non-chronic or light health problems; that is, chronic and incurable cases were excluded. We should keep in mind that the National Hospital was, according to its founders’ statement, “strictly a medical institution for the active treatment of diseases of the Nervous System”, and not for “chronic and incurable cases” (Barclay 1992: 7). The same policy and orientation was to be found in the overwhelming majority of nineteenth-century hospitals. On the other hand, most private institutions were addressing to patients belonging to the middle and upper social classes. These patients were coming from wealthy families, able to afford their hospitalization and not actually caring for its duration. Quite representative was the advertisement of Northumberland House that declared that it “was established in the year 1814 for the care and treatment of Ladies and Gentlemen of the upper and middle classes” (Anonymous 1916: 30). In a way, most (mental) asylums and similar private institutions were some kind of convalescent homes, where those suffering from chronic and incurable diseases could find a shelter, and where doctors and nurses could guarantee the provision of constant medical care and treatment. Without doubt, private institutions’ inmates and their families did not face, as a rule, any particular economic problems; so, they were not usually forced to return to their works after their discharge. Hence, they had the possibility for prolonged hospitalization; this fact became quite obvious through the examination of the two private institutions’ medical files. On the contrary, the majority of the National Hospital’s patients belonged to the working classes. Consequently, they quite often neglected their health, so as not to lose their wages and put in danger the survival of their family. Therefore, it was a matter of life and death for these patients, whose condition of health had been mostly deteriorated and whose hospitalization was considered entirely necessary, to hope for their immediate recovery and, hence, for the shortest possible stay at the hospital.

At this point, some representative examples are definitely necessary. To begin with, quite illuminative was the case of the eleven-year-old A.B., hospitalized in 1889, who, without any professional and family obligations due to his age, remained at the National Hospital for about four months (Jackson 1889: 53–62). On the other hand, the twenty-four-year-old labourer J.B., married and father of one child, was hospitalized, in 1890, for less than thirty days (Jackson 1890: 87–99). The same did actually happen in the case of the twenty-five-year-old J.W.R., a labourer too (Jackson 1890: 785–797), as well as of the fifty-three-year-old J.R., engineer and father of seven children (Jackson 1892: 797–813). Furthermore, quite indicative was the case of the twenty-year-old miner T.B., who was hospitalized in 1889 for six months after an operation to treat his seizures (Jackson 1889: 63–112). Without implying that the length of hospitalization could actually be a personal choice and decision of the epileptic patient, and without underestimating or degrading the decisive role of the doctors, the treatment’s success and a series of other, often quite accidental factors, however, we should once again underline the importance of the economic and social factor. The patients’ occupational status and the social class they belonged to, determined, to a great extent, not only the exact moment when they “decided” to get hospitalized, but also their “choice” of a specific institution (public/charitable or private, hospital or asylum) and everything that this choice could, in fact, imply; that is, the duration of their hospitalization, the necessary time for their recovery, the general conditions of their hospitalization (among others, bigger wards and better menu for the rich patients), etc.

Additionally, a second point that should be definitely highlighted is the transformation and centrality of the notion of “time”. For E.P. Thompson, the passing from a pre-industrialized to a developed industrialized society and a capitalist way of production induced a very deep restructuring of the working habits and conditions, as well as a radical transformation of the concept of time, in general (Thompson 1967). Until at least the mid-eighteenth century, the time that could be measured and counted was an exclusive privilege of the upper social classes, used sometimes as a symbol of social status and political power. At the same time, the lower social classes had adopted a rather indeterminate rhythm of organizing and managing both their daily life and their working day. As there had been no special need for a strictly definite time, most people were involved in periods of either intense occupation, or loose inertness. Nonetheless, the advent of the capitalist society and the concomitant form of productive relations constituted people’s time in an entirely different way. During the nineteenth century, the propaganda for a “healthy” economy of time was actually bombarding the body and mind of the working classes. For, time was now clearly identified with the produced profit and the value of the labourers’ workforce, while every commodity produced was defined and calculated according to the working time spent for its production; “[h]ence it is self-evident that the worker is nothing other than labour-power for the duration of his hole life, and that therefore all his disposable time is by nature and by right labour-time, to be devoted to the self-valorization of capital” (Marx 1982: 375). On the other hand, beyond the connection between industrial time and capitalist profit, the working time was being transformed into a problem regarding the workers’ physical and mental health. Due to the rise of the working day’s limits and the introduction of night shifts by many factories, the employers were usurping, in a way, the time that was valuable for the development and retain of the worker’s well-being.⁷ For this reason, it was during the nineteenth century when the first ‘Factory Acts’ were issued, concerning the restriction of the working hours and the limitation of night shifts – especially, in the case of the supposedly “weaker”, physically and emotionally, women and children.

So, after all, these transmutations could actually explain not only the habit of postponing hospitalization and taking advantage of just one additional working day, but also the wish for the shortest possible hospitalization – quite often, independently of its outcome, as we are going to see next. All in all, the above observations undoubtedly indicate the historicity of the notion of time and its consequent emergence as a social, economic, political and cultural product that took its modern form through a very specific historical need and imperative for healthy and docile bodies, adjusted and regulated with mechanical perfection for the maximum possible efficiency and profit. It was a novel conception of time that proved to be valuable for the regulation of the capitalist system and the incessant production of profit, as well as absolutely necessary for the protection of the physical and mental health and the perpetuation of the capability of the working, industrial man. Around this twofold meaning and operation of time, modern man has learnt to orbit and construct his/her life and death.

The third category under examination refers to the prescribed treatment for John Hughlings Jackson’s epileptic inpatients, during the period 1870-1895. After the quite analytical presentation of the prescribed treatment during the various subperiods, it would be of no special interest to refer to the percentages and exact numbers of every medicament separately. It probably suffices to underline the undoubted preponderance of potassium bromide, which was, as a rule, accompanied by sodium biborate, belladonna, potassium iodide, camphor, chloroform, chloral, arsenic and, less often, glycerin, quinine, cold douches, galvanic and faradic currents, alcohol – usually, whiskey and brandy – valerian and cocaine. A diachronic comparison of the prescribed treatment in the various subperiods just confirms the order of precedence of these medicaments in the therapeutics used not only by Jackson, but by the ensemble of the National Hospital’s doctors. Already, in the 1880s, the adoption and use of potassium bromide had been rendered a continuously expanding therapeutic practice. As it was asserted by Dr. A.H. Bennett, “[b]romide of potassium is generally recognized as the most effective anti-epileptic remedy we now possess” (Bennett 1884b: 18). Quite characteristically, the most famous mid-nineteenth-century physicians – among others, W.R. Gowers, J. Russell Reynolds, E.H. Sieveking, C.B. Radcliffe and J.S. Ramskill – were using potassium bromide ad nauseam for the treatment of epileptic, as well as hystero-epileptic, seizures, enriching it almost always with a variety of the aforementioned drugs. Besides, polytherapy was the most common method; namely, the simultaneous use of many medicaments in various combinations, aiming at the fastest and most efficient relief of epileptic patients. As Gowers underlined, “[t]he value of the various combinations of bromide with other drugs was tested, as far as possible, on a uniform plan” (Gowers 1880b: 553).

This preeminence of potassium bromide was also apparent in the medical files of the two private institutions that were examined. Both at the Manor House Asylum and the Holloway Sanatorium, patients’ seizures were usually treated by potassium bromide, which was quite often accompanied by chloral, cold douches, potassium iodide and purgatives. The only difference in the prescribed treatment between these two institutions and the National Hospital was the quite often resort to the so-called “leave of absence”, which we have already discussed in the fourth chapter. The direct contact with nature and fresh air, the healthy and balanced diet, along with the snugness of their family and friends, were considered as absolutely necessary for the substantial improvement of the condition of epileptic patients’ health. Of course, the following points should not be omitted or ignored: first, the fact that private asylums’ inmates could actually afford either to go to a sea resort for a time period, or to acquire a country residence for this purpose; second, the fact that the National Hospital’s doctors, having evaluated the decisive role of a healthy and tranquil environment, proceeded to the foundation of the Chalfont Colony in 1894, which was mainly focusing on the rehabilitation of epileptic patients after their discharge from the hospital.

Furthermore, it should be noted that this turn towards the use of various antiepileptic drugs did by no means negate, or even underestimate, doctors’ quite intense scepticism, leading them often to an overall pessimism, in regard to the possibilities of epileptic seizures’ successful confrontation and epilepsy’s treatment, in general. Let us invoke Sieveking, who began his major treatise On Epilepsy and Epileptiform Seizures. Their Causes, Pathology, and Treatment, with the declaration that “[t]he history of epilepsy, more than of other affections of the nervous system, until the most recent periods has been the history of one of the weakest sides of medical science; it exhibits the inadequacy of our therapeutic measures to cope with a mysterious power in a painful degree” (Sieveking 1861: 1); and, he concluded by stressing that “[i]n fact, there is not a substance in the material medica, there is scarcely a substance in the world, capable of passing through the gullet of man, that has not at one time or other enjoyed a reputation of being an anti-epileptic” (Sieveking 1861: 299). Accordingly, John Russell Reynolds underlined that “[p]erhaps no disease has been treated with more perfect empiricism on the one hand, or more rigid rationalism on the other, than has epilepsy. Unfortunately both methods have often and completely failed” (Reynolds 1861: 318). Even, John Hughlings Jackson, in an article published in the British Medical Journal in 1888, emphasized that it was a well-known fact that epilepsy’s treatment had so far been entirely unsatisfactory (Jackson 1888b). Nonetheless, the attempts to systematically explore and apply new therapeutic techniques and practices, especially, from the mid-nineteenth century onwards, had as a result the gradual abandonment of the above, rather pessimistic scepticism, and its replacement by a relative optimism. As it was noted by A.H. Bennett, “it would seem that we are not to be deterred from treating cases of epilepsy, however chronic they may be, as the results appear to be as good in modifying the attacks in old, as in recent ones” (Bennett 1884b: 31–32). This turn of neurologists’ attention towards epilepsy’s treatment and their growing optimism concerning the potential result were quite obvious in the majority of mid-nineteenth-century medical texts and treatises. Some illustrative examples seem rather necessary.

Let us invoke once again Sieveking’s treatise, where the famous physician devoted a great part of his work to both the procedures that should take place during the manifestation of an epileptic seizure and the measures that should be taken in the intervals between them (Sieveking 1861). Through the presentation of a series of cases of his private patients, he focused on two basic points; on the one hand, he attempted to explore the efficiency of a series of various medicaments and, on the other hand, he indicated the contribution of a series of other factors to the battle for a successful treatment – these factors concerned mainly the patients’ lifestyle, diet and mental state. Accordingly, both Gowers and Russell Reynolds devoted, in their analysis on epilepsy, a significant part to the major issue of proper therapy – of course, they were not the only ones. Respectively, in the majority of current articles, where many and diverse cases of epilepsy were presented, the references to the ways of successfully treating epileptic seizures constituted one of the basic points of every presentation. From this perspective, in the case of the forty-five-year-old W.R., who had one seizure every four to six weeks and was treated by A. Robertson, it was preferred “a combination of the bromide and iodide of potassium, usually, half a drachm of the former and ten grains of the latter,⁸ thrice daily”; with this particular therapeutic method, “the intervals were somewhat prolonged” (Robertson 1883: 492–494). Correspondingly, in the case of another patient, around fifty years old, whose epilepsy had begun after an incident of alcohol abuse, his doctor recommended an enema and a mixture, “both containing bromide of potassium” (O’Neill 1879: 316). Additionally, in the case of the seventy-three-year-old night watchman R.H., who had had three seizures, “at intervals of exactly four weeks”, the doctor recommended “a mixture containing thirty grains of bromide of potassium, five grains of the iodide, and twenty grains of the bicarbonate, to be taken twice daily” (Smith 1879: 938–939).

Moreover, a special emphasis was put upon not only the use and action of potassium bromide in cases of epilepsy, but also its effect on healthy people and its interaction with other substances – such as, opium (Bennett 1884c) – while there were also noted several attempts to find the most proper diet for the treatment of epileptic seizures (Haig 1897). Moreover, even the fact of the gradual appearance of the first advertisements of antiepileptic drugs in mid-nineteenth-century press was indicative of this general interest in the treatment of epilepsy. Quite representative was the advertisement of an antiepileptic drug, published in Reynold’s Newspaper, which promised “a speedy and permanent cure of this dreadful disease” and reassured the readers that this particular medicament was “perfectly harmless, and has a wonderful power of soothing and allaying that irritation and excitement so incidental to epileptics” (Anonymous 1871).

Without doubt, this emphasis upon the therapeutic part of epilepsy – absolutely indicative of its emergence as a purely pathological/neurological disorder – was most clearly reflected in the continuously growing interest in the side-effects of antiepileptic drugs and in the continuously growing number of relevant studies and researches. Already, in the third chapter, we presented quite analytically Jackson’s references to the side-effects of the prescribed treatment in many of his epileptic patients. Some additional examples taken from nineteenth-century neurological studies do actually reinforce our remarks. Quite illustrative was the presentation of twelve epileptic outpatients at the National Hospital; their doctor, William Gowers, focused on the treatment of bromide rash with arsenic (Gowers 1878). As potassium bromide was indeed physicians’ first choice for the treatment of epileptic seizures, mid-nineteenth-century medical journals were full of relevant references. Within this frame, indicative was the case of the twenty-five-year-old V.G. who had “her legs covered pretty uniformly with a discrete pustular eruption”; her case was accompanied with a detailed presentation of the three stages of the skin lesion – i.e., induration, inflammation and suppuration (Boulton 1881: 663–664). Accordingly, extremely interesting was the case of the just fourteen-month-old E.B., who was, at first, suffering from whooping cough that induced him convulsions and who, after his treatment with potassium bromide for about ten days, had “an eruption appeared on the face” (Cavafy 1881: 736). Furthermore, even T.D. Greenlees, doctor at the asylum in the remote British colony of Grahamstown, after a brief reference to the unparalleled results of potassium bromide in the treatment of epilepsy and to the recommended dosage – three daily doses, from twenty to thirty grains – analysed two cases of poisoning (Greenlees 1893). Furthermore, there appeared in mid-nineteenth-century medical journals several comparative researches on the efficiency, as well as on the dangerousness of some antiepileptic drugs; for instance, the comparison between bromide and iodide of sodium, on the one hand, and bromide and iodide of potassium, on the other hand, in relation to their action in a series of pathological disorders, and the final verdict in favour of the former (Hudson 1883).

On the other hand, medication was not the only possible way for doctors to successfully treat their patients’ epileptic seizures.⁹ The resort to surgery was just beginning to consolidate among the rather – until, at least, the mid-nineteenth century – unwilling to accept it doctors, and to constitute the other possible, alternative solution. We have already mentioned that out of the 371 epileptic patients of Jackson just four were undergone an operation by Dr. Victor Horsley, in order to be relieved from their seizures. Both the relatively small number of the surgeries and the fact that they all took place during the last years under examination – that is, the years 1887, 1889 and 1893 – should by no means surprise us. The first clinical operation at the National Hospital took place on 25 May 1886 and was performed by Horsley. The first patient was a twenty-two-year-old Scotsman, who sustained a “compound fracture” on the left side of his skull and who, during the first thirteen days of his hospitalization, had suffered from 2,870 seizures. For this and all the other operations that followed, Horsley was considered to be the one who “initiated the neurosurgery of epilepsy” (Shorvon and Sander 1996: xxxii–xxxiii). However, to return to Jackson’s patients, what is, to our view, most striking was not only the gender and age of the patients who underwent an operation, but, most significantly, the fact that the frequency and intensity of their seizures were serving as the main criterion for deciding which patients should have an operation and which not. From this perspective, it is worth underlining the fact that all four patients were young and male epileptic patients; one patient was seventeen years old, two were twenty years old and one patient was thirty-five years old. Accordingly, it should be noted that all four were quite severe cases of epilepsy, suffering from very frequent and intense seizures. Of course, they were but a few patients, in order to be able to interpret and evaluate the total preponderance of young men. A rather possible explanation could be that, as women’s identification with hysteria had not yet lost its proponents, the treatment of their seizures was often orientated towards psychic methods and practices – that is, a great emphasis was put upon the emotional nature and status of their seizures instead of the purely physiological/neurological one. So, after all, the epistemological criteria were, in all probability, the ones that played the most decisive role in the selection of the patients for operation. As we have already cited in the third chapter, the case of the thirty-five-year-old man, who was suffering from three types of epileptic seizures for thirteen years, undoubtedly underlined the significance of the growing need for more drastic and efficient therapeutic methods.

However, the above processes did not imply an implicit or a blind faith in surgical practice. Due to both its embryonic form and its restricted technological novelties, surgery constituted, at first, the doctors’ final solution and last resort. Besides, there were several significant ethical dilemmas that came about regarding the issue of the patients’ consent. For, surgical practice – especially in cases where patients were not in a state to decide for or against it – did not only raise the question of the violation and desecration of the human body, but it also raised the question of the people’s free will and rights (Fennell 1996).¹⁰ As it was underlined in a text at the beginning of the twentieth century, “every patient of adult years and sound mind has a right to determine what shall be done with his own body; and a surgeon who performs an operation without his patient’s consent, commits an assault for which he is liable in damages” (Fennell 1996: 76).¹¹

In fact, until, at least, the second third of the nineteenth century, the surgical treatment of several pathological disorders was confronted with a relative reservation. Nonetheless, it was gradually beginning to gain adherents and ground. From this perspective, there were many articles that presented cases of epileptic patients who underwent an operation to treat their seizures (Anonymous 1886). Accordingly, quite impressive was the number of researches and relevant articles on issues relating to both the safe administration of chloroform (Pollock 1874; Farr 1883) and the comparison between chloroform and ether as anaesthetics (Ormsby 1882a, b), as well as to the methods and general problems of antiseptic surgery (Anonymous 1879a, b). This new trend in scientific medicine should not be attributed to the new technological advances, or the antiseptic methods of Joseph Lister, that had already been circulated in the 1860s and had, rather impressively, entered in the operating rooms. On the contrary, it was rather these particular advances and methods that constituted the result of this major and decisive turn towards surgery; that is, towards the “localistic” approach of bodily organs and functions that surgery implied and that was beginning to dominate in neurology’s dominant discourse.

Without doubt, the concept of “localisation”, which owed much to John Hughlings Jackson¹² and which, in a way, laid the foundation stone of twentieth-century neurology and neurosurgery, could definitely be integrated within the above process in the case of epilepsy (Greenblatt 1999). From this perspective, the attempt to localise and restrict seizures in particular parts of the brain and the correlative attempts to intervene and correct these disorders, had significant presuppositions and ramifications. First of all, epilepsy’s emergence as a purely neurological disorder was sealed and sanctioned; namely, as a disease that could and should not be restricted in the explanatory framework and the therapeutic methods of both the theological and the psychiatric discourse, and as a pathological illness that only the emergent neurology could, and should, explain and treat. Consequently, a strict demarcation line was set up between neurology and psychiatry; in this way, neurology nominated epilepsy as its registered trademark and the automatisms of epileptic seizures as its object of knowledge par excellence, while psychiatry entrenched itself around madness, with an expansionist trend only towards the continuously ambivalent hysteria and the other neuroses. Furthermore, these attempts indicated, at the same time, the transition from one epistemological theory to another; that is, they illustrated the epistemological paradigm shift within the frame of the dominant medical discourse, as well as the procedures of the construction of scientific knowledge and the production of scientific theories, in general; in other words, they depicted the connection, interrelation and interdependence between science, society, politics and culture. In a way, they indicated the decisive role of power relations in the constitution, consolidation and dissemination of the diverse networks of knowledge, and vice versa. For reasons that are going to be analysed next, neurology has had a leading role in this procedure.

The next element to be discussed is the result of epileptic patients’ treatment at the National Hospital, during the period 1870–1895. On the whole, the result of their hospitalization and treatment at the National Hospital was recorded in 330 out of 371 cases. More specifically, one hundred and seventy-three patients were discharged quite benefited from their hospitalization, as the condition of their health was described as improved, and forty very benefited, with their health being recorded as much improved; the condition of seventy-six patients remained at the same status; one patient got worse; three epileptic patients died, while the result in the case of one patient was described as uncertain – even though the result of his operation was positive. Moreover, twenty-four patients were cured, that is, they were discharged free of seizures, and twelve were transferred to another institution or removed under the care of their family [Table 5.​3]. So, an extremely high percentage of the total number of cases, that is 64.5 %, had a noticeably declining number of seizures and an improved condition of their general health; if we add to this percentage a further 7.3 % of those patients who had fully recovered, then the therapeutic method and practice of the National Hospital’s doctors, in general, and John Hughlings Jackson, in particular, had been successful in 71.8 % of the total number of cases. Accordingly, the diachronic comparison of these data has revealed a relative balance between the various subperiods, with a slight increase in the number of those patients whose health condition was recorded as “improved”, as the years were passing by – obviously, due to the greater experience in the treatment of seizures and the appearance of new drugs, as was, for example, sodium biborate, which was widely used from 1889 onwards.

On the other hand, what is, at first sight, most striking is the significant differentiation between the National Hospital and the two private institutions, regarding the outcome of the treatment. Concerning the Manor House Asylum, in a total of seventeen patients, for whom the result of their treatment was stated, ten inmates died, the condition of two patients remained at the same status, just one patient was cured, while four epileptics were transferred to another institution. Regarding the four epileptic patients at the Holloway Sanatorium, for whom this information was recorded, the condition of only one patient was improved, while two patients died and one was transferred to another institution. So, it seems that the successful treatment of epileptic seizures and the considerable improvement of the condition of their inmates’ health did not constitute the rule in private institutions and asylums. We could possibly assume that the prolonged stay and hospitalization of the inmates, on the one hand, and their social and economic status, on the other hand, often contributed to a less flourishing result. However, we should keep in mind that many inmates tried to avoid, often successfully due to their social stance and status, the doctors’ therapeutic recommendations. Besides, this was one of the most significant differences between public/charitable hospitals, on the one hand, and private institutions and convalescent homes, on the other hand: in the former, the main objective was the shortest possible stay of their patients and the successful treatment of the usually acute/non-chronic and curable disorders from which they were suffering and for which they were hospitalized; in the latter, the aim was the provision of shelter and care for those people suffering from any kind of chronic and incurable diseases, and the prospect and, sometimes, the pursuit of their stay there, often, until their death; for, we should not forget that the cost of their stay was rather high. For this reason, there were many private asylums’ inmates, whose death was induced by causes totally different from those that had initially provoked their seizures and for which it had been necessary to get hospitalized; that is, their death was, usually, the result of their prolonged stay at the institution. Quite illustrative was the example of the twenty-nine-year-old A.H., hospitalized in 1874, who was occasionally suffering from epileptic seizures and who, after an almost seven-year stay at the Manor House Asylum, died due to “exhaustion from attacks of gout” (Manor House Asylum 1870–1884: case 71). Accordingly, indicative was the case of J.W., forty-seven years old, who, despite the fact that she had entered the asylum in 1874 in a state of “furious excitement” and with “one well marked fit”, died by “exhaustion”, “after lung disease” (Manor House Asylum 1870–1884: case 65).

Nonetheless, we should notice that the result of epileptic patients’ hospitalization was an element that was very rarely omitted, as it was this specific element, which could, in a way, indicate the degree of success of the prescribed treatment. A quick look on current medical journals suffices. To begin with, a Mr. T, who had had one attack of epileptic mania, after the prescribed treatment, “considers himself to be in as good health as he had been at any former period of his life” (O’Neill 1878: 148–149). Respectively, the seventy-six-year-old night watchman, R.H., who was suffering from epileptic seizures due to “cerebral congestion”, was described, after the surprisingly successful treatment of his fits, as “stout in body, and enjoying good health” (Smith 1879: 938–939). Accordingly, the condition of health of a young woman, twenty-one years old, who was suffering from hystero-epilepsy, was considerably improved, as “when she left the hospital on Dec. 7th she had not had a fit for more than a month” (Sansom 1881: 370). The same happened with the case of the twenty-four-year-old unemployed, J.J., who was admitted to the National Hospital under Dr. Charlton Bastian’s care and who, despite the fact that he had fifty-nine seizures in the first twenty-six hours of his hospitalization, achieved, with the proper treatment, to have “no return of the fits” for a long time after his discharge (Bastian 1882: 307–308).

From the above observations, it becomes quite obvious that a special emphasis was put upon the result of hospitalization, as it did reflect the degree of success and efficiency of the prescribed treatment that was each time used for the confrontation– that is, the decrease – of epileptic seizures. Without doubt, the doctors’ discourse on the result can be easily integrated within the more general discourse on drugs and other medicaments. For, this discourse, too, was very indicative of this remarkably huge and continuously growing interest in the therapeutic part of epilepsy; at some times, even by “neglecting”, in a certain way, the nosological part of the disease. Within this context, through this emphasis upon the successful result of treatment, epilepsy was consolidating as a pathological/neurological disease; it was consolidating as the exclusive possession of the neurologists who had as their duty to discover, each time, the most appropriate treatment and the most ideal medicament, in order to achieve the best, fastest and most efficient results.