Five years ago, in a history conference on memory studies and oral history, Antonis Liakos, professor of contemporary history and history of historiography at the University of Athens, referred to the use of pictures in historical research and writing, underlying that we should not just speak of the pictures, but that we should rather allow the pictures to speak for themselves and narrate their own stories.¹ Within this frame, we are going to attempt to hear the voice of a picture, which, hopefully, has many things to say to us. Of course, the above venture will be materialised in combination with the recognition that the way we see things and, hence, the way we look at, analyze and interpret a picture, a photograph or a painting, is influenced and determined, to a great extent, by our specialized knowledge, our theoretical views, our ideological influences; shortly, by our own perspective. Besides, we should not forget the warning that “[w]e only see what we look at. To look is an act of choice” (Berger 2008: 8).² So, within the frame of this selective, but, at the same time, revealing procedure, what exactly does this picture [Photo I], a photograph of an operation theatre at the National Hospital for the Paralysed and Epileptic around 1900, whisper to us and what exactly does it try to narrate us?

The relatively small operation room immediately draws the attention of anyone who is looking at it. It is circumferentially covered with white, rectangular, even tiles, which are interrupted, in their northern part, by a big window consisting of three rectangular, dark-fired glass leaves. Exactly on top of them, one can barely discern a series of several tall, narrow, rectangular glass leaves, with a slight inclination to the front – possibly, this can be the balcony where medical students and internal surgeons had the opportunity to stand and watch the surgeries that took place in the operation theatre. The floor is covered by a mosaic in equally light colours and paintings, where one can barely discern the plays of the more bright colours. A group of four lamps is hanging disproportionally, and rather “disorderly”, from the ceiling; their target is the most possible efficient lighting and the most possible visibility of every part of the operation room. On the right corner of the room, a series of, possibly wooden, shelves contain other instruments and few small boxes on them, which, in all probability, enclose some additional objects for the surgical procedure. On the left, two nurses dressed in a white robe, having just sorted out the surgical tools on the tables next to them and having chosen the appropriate ones for the surgery, are ready to transfer them to the surgeons. At the centre of the room, the three doctors are standing around the body of the patient covered with white sheet and are entirely focused on their duty – that is, their “invasion” into the patient’s brain. Their white dresses (robes and aprons), their also white caps and the white sheets that one can discern from every visible corner of the surgical table, immediately refer to the new aseptic and antiseptic methods and techniques, which have, some decades ago, begun to prevail in the majority of European surgeries. In the background, three more nurses are watching the whole procedure extremely carefully and are ready to assist if necessary. All over the operation room, there are various kinds of instruments and several tables with basins of various forms and sizes, as well as tools, trash and various objects. The viewer can easily discern the head of the patient, on which the three surgeons are focusing with, almost religious, devotion. His body is not visible, being covered with white sheet. So, what exactly could we actually deduce from the abovementioned elements?

In this particular operation theatre, dating back around 1900, there are, almost exclusively, dominating the neutral white colour and the obvious attempt for the imposition of order, strict hygiene and sterilisation rules. Accordingly, there is noted an almost “reverential” dedication to the procedure, as well as to the specialized and discrete roles of the persons, who are actively participating in the operation, and the concomitant highlighting of the role of the surgeons. At the same time, there is a total lack of any kind of direct references to the patient. In this way, the patient is just being transformed into another random, depersonalized “case”; any element of personalization is removed from the photo, following the rigorous and austere, examining medical gaze.

Through this visual representation – as it is going to be the case with the verbal and graphical representations in the patients’ medical files that we are going to examine in the following chapters – there can be clearly discerned the turn towards the scientific and purely neurological confrontation, explanation and treatment of epilepsy, along with a series of other disorders of the central nervous system and the brain. The operation theatre, the surgical table, the surgical scalpel, even the surgical apron, constituted, among others, the confirmation of this major rupture that indelibly marked nineteenth-century scientific medicine. During the second half of the nineteenth century, the window to the human brain had been rendered wide open and the view to and entrance in its secrets had become possible for the scientific, medical perspective. Without doubt, epilepsy’s emergence as a purely neurological disorder has been a novel phenomenon, with social, political, cultural and epistemological consequences and ramifications.

In this procedure, the role of the National Hospital for the Paralysed and Epileptic as the first hospital specialised in neurological disorders, as well as the contribution of the theoretical and clinical work of John Hughlings Jackson, who is considered as one of the most emblematic figures not only at the National Hospital, but also in the history of British neurology, have been decisive. Additionally, we should admit that, despite the indisputable key role of both the National Hospital and John Hughlings Jackson in neurology’s emergence as a distinct scientific field, the choice of this particular institution and of the medical files of Jackson’s epileptic patients was essentially made due to reasons of historical contingency. For, the National Hospital, being the world’s first neurological hospital, has today an impressively organized and accessible archive that rendered it our first and obvious choice in comparison to other London hospitals and asylums. Thus, having elucidated the reasons of choosing our research topic, in order to be able to understand the significance of this major rupture that took place during the second half of the nineteenth century, it would be useful to attempt to answer the following question: in what way do we nowadays approach and perceive the illness of epilepsy? Or, more accurately, how exactly do we approach and perceive epilepsy as a distinct neurological disorder in our days?

“From the onset of recorded history man has been aware of epileptic seizures” (Solomon et al. 1983: 1). It is with this particular phrase that the authors of a late twentieth-century neurological textbook chose to begin their narration on epilepsy’s history and evolution from Antiquity until our days. For, as we are going to see, it is a fact that epilepsy has been approached and defined as a distinct problem, already from humanity’s very first steps. However, as it is most commonly the case with the majority of physical and mental disorders, most people’s knowledge on epilepsy and its history is quite inadequate and relatively vague. So, it is quite common to identify epilepsy with a particular type of epileptic seizures; namely, the generalized tonic-clonic seizure that presents the most intense and identifiable symptoms – i.e., loss of consciousness, unceasing tonic and clonic convulsions, foaming at the mouth, biting of the tongue, etc. In this way, most people tend to ignore epilepsy’s complex and “striking” character. Of course, our target is, in no way, the writing of another neurological/neurosurgical treatise, as, apart from the lack of the necessary specialized knowledge, the orientation of our research is distinctly different. Nonetheless, it is worth mentioning some general points that are going to be rather useful towards a more thorough examination and analysis of the subject.

“It is generally believed by researchers that most epileptic attacks arise from a small collection of abnormal neurons in the brain and that the resulting discharge then propagates itself by physiological pathways to involve adjacent or remote areas of the brain according to anatomically favourable principles” (Solomon et al. 1983: 9). Even though this definition might sound to any non-specialist a little “awkward” and difficult to fully understand it, it definitely succeeds in introducing us to the core of the subject; namely, the human brain. According to contemporary scientific criteria, people suffering from epileptic seizures are defined and confronted by neurologists and neurosurgeons as persons whose brain presents intermittent dysfunction (Theodore and Porter 1989). In this way, epileptics’ brain is identified with the essence of epilepsy. After all, as it became quite obvious through the operation theatre’s picture and as we are going to demonstrate in our analysis, this is, in all probability, the major point that we should take into account when dealing with the history and course of the disease.

In addition, another point that it is worth mentioning is the fundamental differentiation between epilepsy and epileptic seizures, as most people tend usually to confuse and identify the one with the other. An epileptic seizure is a finite incident with a specific start and a specific end, while epilepsy is “a chronic disorder” (Theodore and Porter 1989). According to Professor Fritz E. Dreifuss, “seizures are to epilepsy as a cough is to pneumonia” (Dodson 2004: 8). Moving on from this basic principle and following the 1989 classification proposed by the “International League Against Epilepsy”, epilepsies are classified according to their localization in a particular part of the brain and according to their etiology. In this way, they can be divided into partial epilepsy, generalized epilepsy, epilepsy undetermined whether partial or generalized and special syndromes. More particularly, partial and generalized epilepsies can both be further subdivided into idiopathic (unknown cause), symptomatic (known cause) and cryptogenic (implied, but not definitely known cause) epilepsy (Theodore and Porter 1989; Tatum et al. 2009). Epilepsies undetermined whether partial or generalized may include neonatal seizures, Landau-Kleffner syndrome, etc., while special paroxysmal disorders refer to febrile convulsions, seizures occurring as a result of toxic disturbances, etc.

According to the 1981 classification proposed by the “International League Against Epilepsy”, epileptic seizures are equally classified according to their localization in a particular part of the brain and the involvement of both hemispheres, or not, and are divided into partial epileptic seizures, generalized epileptic seizures and unclassified seizures (Dodson 2004; Tatum et al. 2009; Solomon et al. 1983; Theodore and Porter 1989). More specifically, partial epileptic seizures, which can be evolved into generalized, can be located in a focal cerebral region (tumours, malformations, etc.). They are divided into partial seizures with elementary symptomatology (simple partial), partial seizures with complex symptomatology (complex partial) and partial seizures secondarily generalized. On the other hand, generalized epileptic seizures are produced by discharges that simultaneously affect both hemispheres; in this way, the patient’s consciousness is, as a rule, lost or impaired. They are divided into absence type seizures (“petit mal”), generalized tonic-clonic seizures (“grand mal”), generalized clonic seizures, generalized tonic seizures, generalized atonic (astatic) seizures and generalized myoclonic seizures; all types present a variety of distinct symptoms and clinical manifestations. From the above classifications, it becomes apparent that epilepsy and epileptic seizures do not constitute a homogeneous entity. On the contrary, they actually present a great variety of symptoms that begin from the simple automatisms that one can find in absences and end up to the incessant convulsions of “Status Epilepticus”. Besides, we should definitely underline the difficultly of the diagnosis, especially in cases of idiopathic epilepsy, where etiology is unknown. In any case, epileptic seizures are usually treated by antiepileptic medication and sometimes by surgery, after the complete and thorough examination and neurological evaluation of the patient’s condition; among other things, through the patient’s medical record, his full neurological examination, the EEG and MRI findings, as well as the surgical evaluation through PET and SPECT (Theodore and Porter 1989).