RECORD OF SEIZURES FOR YEAR ENDING JUNE 30, 1917

Dr. WILLIAM T. SHANAHAN, Medical Superintendent, Craig Colony for Epileptics:

DEAR SIR.— I herewith present a review of the work of the male admission service during the year ending this date.

One hundred and thirty-one admissions passed through the service. In ages they varied from 19 months to 72 years. It is a regrettable fact that the cases of this series gave a recital of frank epileptic symptons for an average of 11 years, prior to their application for admission. It thus becomes obvious that if the Colony is ever to be allowed to demonstrate the fullest possibilities of its care and treatment of epileptics, it must not be handicapped by such a chronicity of the disorder. In spite of this long average duration of the epilepsy in the cases herewith reported, it is a satisfaction to note that the proportion of cases, who had been afflicted not more than a year prior to their admission, is greater

than ever before. There were 16 such cases.

With an epilepsy of 5 years standing or less, there were 54 cases. Through the campaign of education which is being waged throughout the country for a more practical application of physical and mental hygiene, epilepsy is receiving attention and benefit is sure to come to its sufferers. The Colony must have extra-mural as well as intra-mural activities. The histories set forth the fact the majority of those admitted would earlier have sought Colony life had they been so directed. If the child or adult who have had their first seizure would promptly present themselves, or be presented for special care and treatment, not only would the welfare of the individual be better served, but the student of the epilepsies be given greater opportunities for practical results by a knowledge of the complex in its earliest stages. To this end, this service in conjunction with the pathological laboratory has assisted in the preparation and demonstration of the Colony exhibits which have been made during the past year. At the medical clinics held at the Colony January 16th and May 15th of the present year, 21 cases of this series were presented, being selected to show the more common aspects of the disorder.

I would emphasize that we are frequently admitting epileptics of high mental and social grade, who in all probability could live outside the institution were proper supervision at hand. This supervision cannot be well extended by general practitioners, unskilled in the management of the epileptic, nor by lay, field or social workers. There exists a most imperative need that the Colony have an outpatient department sufficiently large and organized to examine at least one thousand epileptics a year. This department could also give the medical supervision mentioned above to those high grade cases, who might continue as productive units in their scale.

Before I pass to a recital of case histories, there are certain generalities gleaned from the series, which may well be set forth. I would have it well borne in mind that this report is an analysis of the cases at hand, studied in an individualistic way, and are not dogmatic conclusions regarding the epilepsies as a whole. No one appreciates more than the writer that 131 cases of epilepsy do not represent all of the groups, combinations and varieties of the disorder that may be met. These analyses have been carried

on at the life level of these cases. The sequence and details as set forth in the histories are such that, I hope, a correlation may be more readily made between the clinical and pathological findings when such occasions present.

In dealing with epilepsy in a clinical way, I am more and more impressed with the unique position of the epilepsies among nervous and mental disorders. The inheritance takes one far into the field of eugenics, the loss of consciousness, the psychotic disturbances, and finally the mental deterioration are rich for psychiatric study. The occurrence of temporary palsies, the exhaustion and prostration of the post seizure state, the gradual somatic changes, until life is carried on, in some cases, at the lowest vegetative level, make epilepsy an object of anatomic and neurologic study. The frequent occurrence of epilepsy at the epochs of greatest ductless gland activity, suggest intensive research into the endocrinopathies, while the intricate problems often suggested in metabolism, open up possibilities which can only be solved by bio-chemistry.

Within this series, we see acts and changes in conduct following the seizure itself which again and again have brought these unfortunates in conflict with the law, we note the loss in efficiency and productiveness, the social failure, and finally the push of the disorder towards dependency, until we are overwhelmed with the magnitude of misery and suffering which these cases represent. The problems of epilepsy, as set forth by this series, offer opportunities to students of widely different tastes, aptitudes and proficiencies. Nowhere in medicine is one privileged to exercise more of real humanity than in the every day Colony care and treatment of the epileptic.

A perusal of the histories of the cases under consideration before their admission to the Colony shows that many times the greatest harm is done these unfortunates by the fatuous enthusiast in medicine, who from a few cases, usually far too small to warrant conclusions, seeks to project his own interpretations into prominence, and deals them out to any and all convulsionists, irrespective of type or cause. These enthusiastic optimists usually view the problem of epilepsy from hypothetical and wished for possibilities.

On the other hand, we have brought to our attention the rule of thumb practitioner, who in treating epilepsy, gallops around a ring, like a circus horse, here and there putting the epileptic over obstacles, such as bromides, drastic and senseless diets, and deprivations of every kind, finally carrying him to a state of semiinvalidism and hypochondria.

Both of the above lines of treatment lead to deterioration. A modicum of conservation would not have been deviod of more beneficial results.

The superficial investigator will always be retarded in recognizing the deeper underlying similarities of many of the epilepsies, by the dissimilarities of the more obvious external manifestations, such as the wide range in seizure types, the kind of individual affected, the course of the disorder, the end results, etc. At this admission service, where these cases of present series have been observed at varying periods of from a week to a year, it is observed again and again that there are a large number of cases which, during their early Colony life, are making a peculiar kind of adjustment to their new reality. These cases, if more closely studied, show certain definite characteriological features, certain peculiarities of make-up, and if the data is at hand, it has been frequently found that years before seizures occurred, they made similar maladaptations to their lot in life. So definite has been this make-up in some cases, that had it been observed before the onset of seizures, the writer feels that with all reasonable certainty he could have predicted that these individuals, if continued under stress, would go the epileptic way, rather than any other. These features constitute the so-called, epileptic make-up, personality, predisposition or constitution. I can see no argument with the prejudiced somatist, who with a full blown epileptic personality before him, and without other obvious or ascertainable factors or lesions for the disorder, chooses to ask the question, "Does there not lie some subtle physical substratum of altered nervous elements, as a basis of the disorder?" To such a one I answer with MacCurdy, "in lieu of a knowledge as to answer the WHY, we endeavor to substitute and answer the HOW."

Up to within recent times, the physician in regard to the epilepsies held to the idea that an early recognition or diagnosis