To begin with, just a few words on the foundation and reception of the National Hospital for the Paralysed and Epileptic. The foundation of the National Hospital was the outcome of an initiative taken by the Chandler family, that is, Johanna, Louisa and Edward Chandler, who were three siblings whose past is barely known. In contrast to the common and ordinary way of founding a specialized hospital, where some doctors undertook the initiative and realized the idea, in the case of the National Hospital – as it was also the case with a great number of general hospitals – it was a movement based, at least, at the beginning, almost entirely upon the charity and compassion feelings of some well-off individuals (Granshaw 1989). Seeing their beloved grandmother paralysed and without any possibility of having access to specialized medical treatment, the Chandler family reflected on the afflictions of people who were suffering from this kind of disorders; especially, of those who did not have sufficient means to afford a proper treatment (Chartered Society of Queen Square 1960). In a period when there was no special medical provision neither for epileptics nor for the majority of those suffering from neurological disorders – both in London and in the countryside – these patients were quite often confined within asylums and workhouses, since general hospitals, as well as many infirmaries, specialized hospitals and psychiatric asylums, usually rejected similar cases under the pretence of the better living conditions and security of all the other inmates (Shorvon and Sander 1996). One rather illustrative example is an advertisement by the Bethlem Royal Hospital, where it was clearly stated that “patients of the educated classes, in a presumably curable condition, are alone eligible for admission”, while the institution rejected those who, among other things, “are in a state of idiocy or subject to epileptic fits” (Anonymous 1916: 40; emphasis added). Moreover, there were many mid-nineteenth-century articles emphasizing the poor living conditions of epileptics within asylums and the imperative need for the segregation of men and women and their placement in a better and more humane environment (Anonymous 1867, 1870).

Within the more general frame of the ongoing specialization of medicine during the nineteenth century, the simultaneous and spontaneous offering by many members of the middle and upper social classes, and the mobilization of David Wire, Lord Mayor of London (Chartered Society of Queen Square 1960),¹ the National Hospital for the Paralysed and Epileptic (first called, the National Hospital for the Relief and Cure of the Paralysed and the Epileptic), the first neurological hospital in the world, opened its gates in May 1860. As it was most clearly stated by its founders, the National Hospital was “strictly a medical institution for the active treatment of diseases of the Nervous System” (Barclay 1992: 7). It immediately succeeded in raising considerable interest in the neurological dimension of epilepsy and a series of other neurological disorders, leading to the foundation of six more institutions with neurological orientation in London, the decade that followed its opening. Probably, the most famous was the Regent’s Park Hospital, founded in 1866, which became, afterwards, known as the Maida Vale Hospital for Nervous Diseases (Shorvon and Sander 1996).

The hospital’s foundation was warmly welcomed by Victorian society and it was, in fact, flattered by mid-nineteenth-century press. It is quite characteristic that Victorian newspapers continued to cover with praise the course and evolution of the National Hospital during the first years after its opening. This very positive and favourable attitude came into sharp contrast with the prejudice and polemics that the overwhelming majority of specialized hospitals had faced, not only by members of the medical elite, but also by press (Granshaw 1989). It is indicative that, according to the British Medical Journal, specialized hospitals did not serve any actual purpose, were spending public money and would not contribute to scientific research and progress. However, the case of the National Hospital was completely different, as it was addressing a category of patients who were usually rejected by other institutions. For this reason, its reception was really ardent. Several articles in the Daily News were quite expressive and passionate. For example, on 18 June 1869, an article devoted to the hospital underlined that “ten years ago London had no such hospital”, highlighting that “the place is always full, and the out-patients always a thousand strong” (Anonymous 1869). Accordingly, on the occasion of the opening ceremony of two extra wards on 10 January 1868, another article provided a detailed description of the hospital’s interior and equipments: “[t]he new building offers accommodation for sixty in-patients, and is provided with every appliance which modern scientific ingenuity has devised for the treatment of the disease” (Anonymous 1868). In the same article, it was stated that in 1865, the number of its inmates had reached thirty-five, while, between the opening of the hospital in May 1860 and January 1868, the number of the outpatients who had received medical treatment reached the impressive number of eight thousands. Even at the twenty-ninth anniversary of the hospital’s opening, there were many relevant references to be found in the newspapers and scientific journals; for example, an article in the Lancet stated that there were in the festive dinner “about hundred and fifty ladies and gentlemen, including doctors at the hospital”, highlighting that “during the last year [1888], not less than five hundred members of the medical profession (not working at the hospital) had studied within its walls, paying no less than 1,900 visits to its wards” (Anonymous 1889: 1109).

Within the frame of the hospital’s unique importance, John Hughlings Jackson (1835–1911), having studied at the York Medical and Surgical School, began working at the National Hospital in 1862 and remained in its staff until 1906. Next to renowned physicians of his period, such as Charles-Édouard Brown-Séquard (1817–1894), Jabez S. Ramskill (1825–1897), Sir John Russell Reynolds (1828–1896), Sir David Ferrier (1843–1928), Sir William Richard Gowers (1845–1915) and Sir Victor Horsley (1857–1916),² his work was not restricted to its clinical and writing dimension, but was actually extended to the consolidation of neurology as a distinct scientific field (York 1999). In 1878, he was one of the founders of the Brain, in 1886 he was the first president of the newly-founded ‘Neurological Society of London’, while, in 1892, he proceeded to the foundation, along with other National Hospital’s doctors, of the ‘National Society for the Employment of Epileptics’. For his significant contribution, he has been called by the famous American neurologist William G. Lennox “the father of British neurology”; as Lennox himself highlighted, he “subjected the ancient ill of epilepsy to the genius of his scrutiny, and thereby opened a door of hope on this hitherto hopeless disease” (Tyler 1984: 56). Without doubt, after Jackson and his work at the National Hospital nothing would be the same for epilepsy and epileptics.

To begin with, we should mention that, on the whole, our research has focused on the medical files of Jackson’s 1,453 inpatients, 783 men and 670 women, during the period 1870–1895.³ From these 1,453 inpatients, 371 – particularly, 186 men and 185 women – were clearly defined as suffering from “epilepsy”, or as suffering from (“epileptic”/“epileptiform”) “fits” – either from fits as such, or from fits accompanied by another neurological or mental disorder. Those suffering from “hysteria”, “functional fits” and “epileptic hysteria” were not included among them, with the exception of those suffering from “hystero-epilepsy”. Moreover, there were several cases that could be possibly included in the category of epileptic patients, if we took into account modern scientific standards – for example, many patients presented some types of seizures as a result of cerebral tumours, cerebral haemorrhage, hemiplegia, etc., whose nature was not specified by Jackson. However, the point is to examine the specific categorizations of the nascent neurology and the ways Jackson used to categorize his patients. For this reason, our analysis is based exclusively upon Jackson’s specific entries in the category “disease”.⁴ It is his diagnosis that matters, so as to avoid any possible anachronisms and misleading conclusions. Within this frame, those suffering from epilepsy or fits presented a variety of symptoms that extended from simple absences and tonic and clonic seizures, to generalized tonic-clonic epileptic seizures. In this way, they can actually be included, to an extent, in the twenty-first-century notion and conception of the disease. On the other hand, we should highlight that a subdivision of the period 1870–1895 was necessary, especially, for a more efficient analysis and comparison of the data.⁵ The first years 1870–1879 – with the exception of 1878 for which there are no available data – are going to be examined as a whole; during this period, the assemblage and record of the hospital’s data were in a rather initiatory stage, not only quantitatively, but also qualitatively. The remaining years 1880–1895 are divided into three subperiods: namely, the periods 1880–1885, 1886–1890 and 1891–1895.⁶

Let us begin with the first period under examination, that is, the years 1870–1877 and 1879. During this period, 100 patients were hospitalized at the National Hospital, under the care of John Hughlings Jackson. From these 100 cases, 36 inpatients – 16 men and 20 women – were clearly defined as suffering from epilepsy or (epileptic) fits. At this point, it should be highlighted that epilepsy outnumbered all other diseases, constituting 36 % of the total number of cases – on the whole, during the 1860s and 1870s, almost 50 % of the hospital’s inpatients and an even higher percentage of its outpatients was suffering from epilepsy (Barclay 1992). Then, there followed some major neurological disorders; hemiplegia counting sixteen cases, locomotor ataxia and cerebral tumours counting three cases, disseminated multiple sclerosis and hysteria counting two patients, etc.

Each patient’s medical file was, to a great extent, a quite thorough account – gradually, more detailed as the years were passing by – that included a variety of data and that was following the dominant pattern to be found in nineteenth-century hospitals’ files. During these first years, the first page constituted the doctor’s introduction into each case. In most cases, there were quoted on the first page the patient’s name, his/her age and gender, the date of admittance to the hospital and the date of discharge, and, of course, the disease from which the patient was suffering, the time between epilepsy’s first manifestation (i.e., the first epileptic seizure) and his/her admission to the hospital and the result of hospitalization. In a few cases, there were recorded the patient’s marital status, his/her occupation and his/her address of residence.

Next, a series of categories enabled the construction of a more thorough and elaborative report on each case. “Family history” consisted of a comprehensive description of each patient’s family tree that began from his/her parents and his/her brothers and sisters, extending to his/her great grandparents. A special emphasis was put upon the existence of neurological and psychiatric disorders, without neglecting all other diseases that could have, in one way or another, influenced the patient’s current state – for example, phthisis, typhus, rheumatic fever, asthma, heart and respiratory problems. “History” referred to any kind of health problems that the patient had faced until his/her admission to the National Hospital and, then, to the course of the current disease (i.e., epilepsy) from its first manifestation up to its present status. In this way, the first epileptic seizure was described, with a special emphasis on its cause – in case it was known to the doctor, mainly, through the accounts of the patient’s family and friends – the usual character of the next seizures, as well as their frequency. In some cases, there was an extra category, entitled “present condition”, where it was analytically described the disease, that is, the type of epilepsy, and the character of the seizures, while, in a very few cases, there was also a reference to the patient’s “daily record”, namely, to the daily recording of his/her seizures and their character while hospitalized at the National Hospital. In few cases, there was a special reference to the patients’ “mental condition”; among other things, to the state of their memory, their ability to speak and articulate various words, their intellect and ability to answer questions. Finally, in a small minority of patients, there was an extra diagram that included the exact date when the patient did have a seizure, the total number of seizures, the character of every seizure and the prescribed treatment [Photo II].

Next, it would be very useful to present the various elements separately, as it is going to enable us to proceed to their comparative and qualitative analysis and, consequently, to the evaluation of epilepsy’s and epileptics’ status in England, during the second half of the nineteenth century, in the next two chapters. During the years 1870–1877 and 1879, there were hospitalized at the National Hospital under Jackson’s care thirty-six epileptics, sixteen men and twenty women. First of all, if we go forward to an examination of the patients’ marital status, several interesting elements come about, especially, in reference to the degree of socialization and acceptance and, accordingly, to the extent of isolation and marginalisation by their family and social environment. In this way, out of sixteen epileptic men, four were married and two were single, while the patients’ marital status was not recorded in ten cases. On the other hand, out of twenty epileptic women, one was married, one was a widow and six were single, whereas the marital status was not recorded in twelve cases. This omission, which we are going to notice also in other categories, was mainly noted in the case of children and young people under sixteen years old; however, at the same time, it was noted in the case of older people, as well. Maybe, we could assume that this particular information remained unknown and unavailable to the doctor, probably, due to the lack of any family members or friends who could have revealed it. Accordingly, if we examine the marital status of those suffering from hemiplegia – that is, the second, more multitudinous category of patients after epileptics – during that same period, the following elements come along: out of six hemiplegic men, one was married, one was single and the marital status was not recorded in the remaining four cases, while out of ten hemiplegic women, three were married, one was a widow, two were single and the marital status was not recorded in four cases. Therefore, we notice that the elements regarding hemiplegics’ marital status were equally fragmentary.

In reference to epileptic patients’ age, which was not stated in just two cases, two patients were up to ten years old, twenty patients were between eleven and twenty years old, nine between twenty-one and thirty, one between thirty-one and forty, one between forty-one and fifty, and one patient was over fifty years old; that is, almost 65 % was under twenty years old and just 9 % was over thirty.

Concerning the time between epilepsy’s first manifestation and the patient’s admission to the National Hospital, we could highlight the following: the time was not recorded in five cases, while three patients had experienced their first seizure for less than a month before their admission to the hospital, seven patients were ill for a period between one and six months before their hospitalization, one for a period between seven and twelve months, eleven patients were suffering from seizures for a period between one and five years before entering the National Hospital, one patient for a period between six and ten years, six for a period between eleven and twenty years, and two patients were ill for over twenty years before deciding to go to the hospital for treatment. So, 64.5 % of the recorded number of epileptic patients was suffering from seizures for more than a year before being admitted to the hospital. Respectively, if we proceed to an examination of hemiplegic patients, the following elements come along: three patients were suffering from hemiplegia for less than a month before their admission to the National Hospital, four were ill for a period between one and six months, one for a period between seven and twelve months, five patients were suffering from hemiplegia for a period between one and five years before being admitted into the hospital, and two patients were ill for a period between six and ten years. No patient was suffering from hemiplegia for more than ten years before his/her admission to the hospital; without doubt, the specific nature and character of each disease determined, along with a series of social and economic factors, as we are going to see in the next chapter, the patient’s decision for hospitalization.

Additionally, regarding the length of epileptic patients’ hospitalization at the National Hospital, it should be noted that it was not stated in twenty cases, while three patients were hospitalized for less than a month, twelve patients for a period between one and six months and one patient stayed at the hospital for a period between seven and twelve months.

During these first years, patients’ occupation and address was rarely recorded. As far as occupation was concerned, it was recorded in just thirteen cases. More specifically, five patients were working as domestic servants, four were labourers, one patient was working as an engineer, one patient as a sailor in the navy, another as a driver, while one child was still going to school. In the case of M.B., who was one of the five domestic servants, Jackson underlined the direct relation between her hard working and her epileptic seizures, as whenever she used to work less hard, she presented longer intervals between her seizures (Jackson 1870–1877: 29–32). Moreover, we should definitely mention the case of the twenty-two-year-old T.B., for whom there was no information concerning his occupation and who, according to Jackson’s own explanatory observation, “he cannot employ himself regularly with any idea of remuneration because such employment almost always brings on fits” (Jackson 1870–1877: 25–28).

As far as address was concerned, it was recorded in just eleven patients: six were living in the city of London and five were living in some place in the English countryside. More specifically, three patients were living in northern London, one in central and two in eastern London, whereas two patients were living in some area in eastern England and three in southern England.

Accordingly, in many cases, there was also noted the prescribed treatment. More specifically, the great majority of the patients was treated with potassium bromide, which was already introduced for epilepsy’s treatment in 1857 and was usually accompanied by nitroglycerin, chloroform and cold douches. Furthermore, in the last two cases in 1879, there was also a reference to the specific dosage of potassium bromide (three times a day), while in the case of the twenty-two-year-old E.G., it was stated that her condition was improved; however, whenever the medication was discontinued, her treatment went back (Jackson 1870–1877: 95–97).

Additionally, in just a few cases, there was recorded the outcome of the patients’ hospitalization at the National Hospital. So, the condition of six patients was described as improved during their stay at the hospital,⁷ one patient remained at the same status – in all probability, there was no change, either positive or negative – whereas four patients were either transferred to another institution, or discharged for various reasons. For example, in the case of the young R.B., she had to be discharged after three or four days at the hospital, as she was found extremely “troublesome” and “violent” (Jackson 1870–1877: 21–24), while another patient was “removed under care of Mother and Father” (Jackson 1870–1877: 177).

Equally interesting are the quite detailed and rather accurate descriptions of several patients’ epileptic seizures. At this point, it should be stressed that family and friends were also giving accurate descriptions of the patients’ seizures; for example, in the case of the domestic servant, M.B., a fifty-five-year-old widow, it was stated that “she knows the kind of her fit, by what neighbours tell her” (Jackson 1870–1877: 29–32). The following descriptions constitute two very illustrative examples. On the one hand, there was the description of the usual character of the seizures of a twenty-two-year-old young man: there was no warning; the fits very rarely happened during day; the patient “convulsed on both sides”; he did not bite his tongue, he foamed, when the seizure went and he used to scream very loud for a minute, or so (Jackson 1870–1877: 25–28). On the other hand, there was the description of the “aura” that preceded the seizures of M.B.: the warning was “well marked” and considered of a “sound like a distant railway whistle”, which was heard in her left ear; the sound was coming rapidly nearer to her until it was very loud and then she became insensible; this whistling lasted only for a second; however, it was not long enough for her to lay herself down and get ready for the fit; it was not like an ordinary “singing to the ears”. Another warning sensation consisted of a “curious sensation of the eyes”, like a flash of lightning from the right to the left eye (Jackson 1870–1877: 29–32).

In parallel, there were some sketchy observations in regard to the cause of the patients’ first epileptic seizure that marked the beginning of their disease. So, in some cases, “fright” by someone or something was recorded as the cause of the first seizure. In another case, the cause was the fact that the patient had seen her sister having a seizure some time ago (Jackson 1870–1877: 187–190),⁸ whereas in the case of the young labourer T.H.T., the first seizure came after very hard work and, then, the patient discovered that it was “sexual congress” that led to an “increase of giddiness and fits” (Jackson 1870–1877: 251–254).

Finally, it would be interesting to try to explore the patients’ view and personal experience of their disease. Besides, as Roy Porter has remarked, “the history of healing is par excellence the history of doctors”; in this way, there is an urgent need for a patient-oriented history, or more precisely, “for a sick people’s or sufferer’s history” (Porter 1985: 175–198). However, keeping in mind that “to focus on experience is also to focus on something manysided and elusive, even inchoate; something that historical agents, like ourselves, could not always understand or express” (Clark 2000: 6–7), we should underline that there was an almost absolute absence of references to epileptic patients’ view and behaviour. In this way, there were no references to the patients’ behaviour within the hospital walls, their attitude towards their doctors and nurses, their intimate thoughts and feelings concerning their disease and the period of hospitalization; in other words, there were no references to those elements that would enable us to explore epileptic patients’ “underlife” – to use Erving Goffman’s term in order to characterize the living conditions and way of behaving of both inmates and staff within the so-called “total institutions” (Goffman 1968) – and to construct a sociology of epilepsy “from below”. In this way, there were only but a few references to epileptics’ character and behaviour, especially, but not exclusively, whenever they became violent or suicidal; that is, it was a verbal representation of their behaviour and character and their general mental status, as they were viewed and interpreted by the dominant medical discourse. The following cases constituted rather indicative examples: R.S. could not stay “quiet in bed” and could not “behave decently at meals”, being also “dirty in habits” (Jackson 1870–1877: 21–24); T.B. was described as showing a “considerable taste for architectural drawing” and being “fond of reading books about architecture” (Jackson 1870–1877: 25–28); the eleven-year-old F.J.S. was recorded as being “given to thieving and lying”, since he used to steal things and then give them to other people (Jackson 1870–1877: 219–221); lastly, during night, the eighteen-year-old J.R. used to get out of his bed and go to other beds, frightening other patients (Jackson 1879: 190–194). Accordingly, there was also a total lack of references to doctors’ and nurses’ behaviour, and their attitude towards epileptic patients. The only remark was made about the case of the seventeen-year-old J.H., who was “obliged to bed” and was “chained on account of mental condition”. Sometimes, the patient was “quite tractable at others” and, since he was suffering from epileptic mania, he required constraint; eventually, he was “removed under care of Mother and Father” (Jackson 1870–1877: 177). From this perspective, the doctors’ “public transcript” and the corresponding “hidden transcript” of the patients, or even the nurses – these two notion that James Scott very aptly used to describe the codes of communication and power relations that dominate the political field, can be easily extended to any sphere of human action that is dominated and diffused by power relations – remain so far unexplored (Scott 1990). We are going to return to this issue minutely in the next chapter.

During the period 1880–1885, 248 cases – 137 men and 111 women – were treated by John Hughlings Jackson as inpatients at the National Hospital for the Paralysed and Epileptic.⁹ From these 248 inpatients, 76 were categorized as epileptic or as suffering from (epileptic) fits/convulsions. Following once again Jackson’s own categorization, epilepsy outnumbered all other neurological disorders, as it was also the case during the first period under examination. Hemiplegia came second with forty-five cases and, then, hysteria followed with twenty-two cases, several types of paralysis with sixteen cases, cerebral tumors with nine, locomotor ataxia with six cases, disseminated multiple sclerosis with four, chorea and nervous breakdown with three cases, etc.

Regarding each patient’s medical file, we should note that, as it happened during the first years under examination, it was once again a detailed account of the patients’ disease, their personal history and the course of the disease during hospitalization. The first page of each medical file constituted once again the doctor’s introduction into the case. The only difference was that, during the years 1880–1885, the recording of the patients’ data became much more systematized. This can be explained, if we take into consideration the fact that there was already a given experience of twenty years in the functioning of the hospital and the collecting and recording of medical data. As a result, a number of elements, which we could find only sporadically in the previous period, were now – especially, after 1881 onwards – being steadily recorded: that is, the patient’s name, his/her age and gender, his/her address of residence, the date of admittance to the hospital and the date of discharge, the disease from which the patient was suffering, the time between the first manifestation of the disease and his/her admission to the hospital and the result of hospitalization, while, in some cases, there was recorded the patient’s marital status and occupation. On the next pages, a series of categories enabled a more thorough and elaborative representation of each case. “Family history” and “history” were the two standard categories that were to be found in almost every case. Again, there were recorded, on the one hand, the patient’s family tree with a special emphasis on the existence of any trace of neurological and psychiatric disorders in the ancestors, and, on the other hand, any kind of diseases that the patient had suffered from, with a special reference to the course of the current disease. Thereafter, “present condition” and “daily record” appeared interchangeably in a number of cases. However, during this period, the difference was that “present condition” did not refer only to the current disorder – that is, the type of epilepsy and the character of seizures – but also to the condition of some other bodily organs. So, there appeared the first references to the condition of the patients’ upper and lower limbs, their heart and respiratory system, their mental and intellectual state, their menstruation (in women), as well as to their sensory organs, with a special emphasis upon the condition of the eyes; we should note that, during this period, there were also recorded the first ophthalmoscopic examinations that were conducted by a specialized doctor. Finally, in almost all cases, there was the extra diagram that included the dates with the patients’ seizures, the total number of seizures, the character of every seizure and the prescribed treatment, whereas, in many cases, there was an additional distinction, according to the seizures’ character, between “slight” and “severe” seizures. Therefore, the medicalization and neurologization of epilepsy and, hence, of a variety of neurological diseases, was continuing to expand at a steady pace.

As far as the various elements are concerned, during the years 1880–1885, we examined the medical files of John Hughlings Jackson’s seventy-six epileptic inpatients, thirty-six men and forty women. First, in regard to men’s marital status, it should be highlighted that it was not stated in thirty-three cases. In the remaining three cases, two men were married and one was single. Concerning epileptic women, their marital status was not stated in thirty-five cases. In the remaining five cases, three women were married and two were single. On the other hand, if we examine hemiplegics’ marital status, the following elements come along: eleven hemiplegic men and seven hemiplegic women were married, two men and one woman were widows/ers, and one man and three women were single, while the marital status was not recorded in twenty cases, thirteen men and seven women. So, in the case of hemiplegics – especially, if one takes into account their relatively higher age average – the marital status remained also very often unknown to the doctor.

Regarding epileptic patients’ age during these years, the following elements emerge: nine patients were up to ten years old, forty-two epileptics were between eleven and twenty years old, seventeen between twenty-one and thirty, five between thirty-one and forty, and just two between forty-one and fifty. No patient was over fifty years old. In only one case, the age of the patient was not stated. We can note that, during this subperiod, as well, the overwhelming majority – that is, 68 % of the recorded number of epileptics – was less than twenty years old, whereas, once again, only 9.3 % was over thirty years old. Undoubtedly, the main issue, which is going to be examined analytically in the next chapter, is whether this steadily high percentage of young epileptic patients should be seen as accidental, or as indicative of both the dominant social attitudes towards elderly people and the extent of epilepsy’s medicalization. For, it has been childhood and youth that began to function, during the second half of the nineteenth century, as one of the starting points for the diffusion and permeation of medical practices and techniques throughout the social body.

Concerning the time between the appearance of the first symptoms of the disease and the patients’ admission to the National Hospital, the following can be noted: two patients were suffering from epileptic seizures for less than a month before their admission to the hospital, eleven for a period between one and six months, seven for a period between seven and twelve months, thirty patients were suffering from seizures for a period between one and five years before entering the National Hospital, fifteen for a period between six and ten years, six for a period between eleven and twenty years, and one patient was ill for over twenty years before going to the hospital for treatment. During this period, the time between the first symptoms and the patient’s admission to the hospital was not stated in four cases. So, 72.2 % of the recorded number of patients was ill for more than a year before being admitted to the hospital. Of course, the fact that many patients were ill for a rather long period of time, did not exclude the possibility of either having been hospitalized at another institution beyond National Hospital, or having been treated by another doctor, or, even, having been treated as outpatients at the National Hospital. Respectively, if we examine hemiplegic patients, the following elements come along: nine patients were ill for less than a month before their admission to the National Hospital, fourteen for a period between one and six months, ten for a period between seven and twelve months, five patients were suffering from hemiplegia for a period between one and five years before being admitted to the hospital, two patients for a period between six and ten years, and one patient for a period between eleven and twenty years. No hemiplegic patient was ill for more than twenty years before his/her admission to the hospital. One might assume that it is by far more difficult to live and work with hemiplegia than to live and work with epilepsy and, as we are going to discuss more analytically in the fourth chapter, this is one of the main reasons why the time for hemiplegics’ admission to the National Hospital was shorter.

In relation to the length of epileptic patients’ hospitalization, which was stated in seventy-one out of seventy-six cases, it should be highlighted that the overwhelming majority was staying at the hospital for a period between one and six months. More particularly, ten epileptic patients were hospitalized for less than a month, fifty-seven for a period between one and six months, three for a period between seven and twelve months, while one patient stayed at the hospital for more than a year. On the other hand, during that same period, seven hemiplegic patients were hospitalized for less than a month, thirty-five remained at the hospital for a period between one and six months, and one patient for a period between seven and twelve months. No hemiplegic patient stayed at the hospital for more than a year. At this point, it should be underlined, even if it strikes the contemporary reader, that the length of the patients’ stay – regardless of the specific disease, as it was noted a relative balance among the various diseases – was relatively short, especially in comparison to private institutions and asylums; as we are going to see in the fourth chapter, the patients’ length of stay depended almost exclusively on each institution’s specific character and scientific orientation.

As far as epileptics’ occupation was concerned, we should underline the following parameters. In forty-four out of seventy-six cases, epileptics’ occupation was not stated; once again, for the same reasons as it had been the case during the previous period under study, namely, either because it was unknown to the doctor or, more commonly, because the patients were children and young people less than sixteen years old. Concerning the remaining thirty-two cases, eight epileptics were working as domestic servants, five as labourers, two women were teachers, two patients were clerks, two were gardeners, one was working as a mechanic, one woman as cook, one woman was occupied with household duties, whereas for one patient it was stated that he used to do “odd jobs” (cleaning windows, etc.). Moreover, three young people were assistants and three children were going to school, while several had left school – as it was stated quite emphatically in one of them: when he was thirteen years old, he was “entirely prevented from going to school due to severe and frequent fits” (Jackson 1882: 457–458). Finally, three patients were recorded as having “no occupation”. In particular, a twenty-six-year-old young woman remained at home with her parents, since she had “never been able to go to service”; that is, her unemployment was attributed to her illness (Jackson 1883–1885: 75–79).