Book Review

The History of Medicine

The Falling Sickness: A History of Epilepsy from the Greeks to the Beginnings of Modern Neurology

N Engl J Med 1994; 331:817September 22, 1994

Article

The Falling Sickness: A History of Epilepsy from the Greeks to the Beginnings of Modern Neurology
Second edition. By Owsei Temkin. 467 pp. Baltimore, Johns Hopkins University Press, 1994. $24.95. ISBN: 0-8018-4849-0

Owsei Temkin is professor emeritus of the history of medicine at Johns Hopkins University and former director of the Johns Hopkins Institute of the History of Medicine. His style is direct and inviting, and he presents even the most complex material in a clear and lucid manner. Scholars may quibble over some points of interpretation, yet nearly half a century after the first edition of this book was published (1945), it remains unsurpassed. Now available as a paperback reprint of the second edition (initially published in 1971), The Falling Sickness is the most authoritative English-language work on the history of epilepsy in the Western world. It is an outstanding reference for those with an interest in epilepsy or medical history.

The book surveys the evolution of ideas in the Western world concerning the causes, pathogenesis, types, and treatment of epileptic seizures. Temkin begins with an account of the Hippocratic text entitled On the Sacred Disease, dated around 400 B.C. This earliest-known treatise on epilepsy set the stage for the conflict between natural and supernatural concepts of the disease, which continued for over 2000 years. Temkin concludes with an analysis of the conceptual changes during the 19th century, culminating in the contributions of John Hughlings Jackson, who laid the foundation for contemporary ideas about epilepsy, and those of Jean-Martin Charcot, who separated epilepsy and hysteria more clearly than his predecessors had.

Temkin points out that the history of epilepsy is closely related on the one hand to the history of neurology and on the other to the history of magic. Medical views of epilepsy were permeated by religious beliefs, popular superstitions, the occult, and fears of witches and demons. Thus, an understanding of these ideas requires the study of views held not only by physicians but also by the laity, philosophers, and theologians. Temkin interprets the evolution of medical ideas about epilepsy in the light of contemporary society and culture. He analyzes historical material as it relates to epilepsy but does not provide a general picture of historical events. Thus, some knowledge of the history of medicine and science enhances an appreciation of the book. Nevertheless, this book provides superb insights into the ideas of medical and human history, since general theories assume a concrete reality when applied to a specific disease such as epilepsy.

Readers familiar with modern classifications of epileptic seizures and syndromes and their causes will find this work compelling. Many interpretations and remedies underscore the misguided struggle to explain the mechanisms of the disease and to link cause and effect or treatment and response. Erroneous concepts were often transmitted from generation to generation, and some persist today. For example, placing an object between the teeth of a person undergoing a convulsion was recommended by Guainerius in 1516. Some of the historical observations are astonishingly accurate. Temkin notes that the account of an epileptic attack given by Theodorus Priscianus, a Latin author of the fourth century, differs little from the description of a generalized tonic-clonic seizure found in a modern textbook: “After various premonitory signs the patient falls down, stretched out or twisted, and in this condition he remains for some time. After these tonic convulsions he passes into the stage of clonic convulsions and a condition where he appears to be sleeping. The attack is followed by complete amnesia.” Excellent descriptions of complex partial seizures with automatism by 16th- and 17th-century physicians brought into question the appropriateness of the name “falling sickness,” a popular term referring to generalized convulsions and applied to the disease since antiquity. Inheritance and head injury have been considered to play a part in epilepsy since the time of the ancient Greeks. For the neurologist, the high point of this book is likely to be the masterly description of Jackson's ideas, which evolved from his clinical observations between 1860 and 1890 and opened the door to an understanding of the function of the nervous system.

This scholarly treatise, based largely on primary sources, is meticulously referenced. Its frequent footnotes quote directly from the original Greek, Latin, French, and German sources. But ignorance of these languages detracts little from an appreciation of the book. It has few illustrations but contains excellent indexes of names and subjects. Epilepsy in prehistoric times and in non-Western societies is beyond the scope of this work, as are developments in neurophysiology, neuropathology, neurosurgery, neuropharmacology, and other scientific disciplines during the late 19th and 20th centuries. Those interested in a more recent history should consult O'Leary and Goldring's Science and Epilepsy: Neuroscience Gains in Epilepsy Research (New York: Raven Press, 1976).

Vicente J. Iragui, M.D., Ph.D.
University of California, San Diego, La Jolla, CA 92093