Weill Cornell Medical College, New York, United States (Summer 2013)
If I wished to show a student the difficulties of getting at truth from medical experience, I would give him the history of epilepsy to read.
—Oliver Wendell Holmes, 1891.1
As the nineteenth century dawned, the average Briton still understood epilepsy much in the way his ancient Greek counterpart had: as a “sacred disease” carried from the heavens to smite the errant. A hundred years later, modern neurology was well on its feet. Clearly, it would be an oversimplification to reduce the cultural history of epilepsy to a before-and-after binary. Nonetheless, the mid-1800s were a landmark moment in the history of epilepsy.2 The atmosphere of radical change at that time provided fodder for and is reflected in some of the most vivid portraits of the disease in the English language. Specifically, we will focus on three texts: Charles Dickens’s Oliver Twist (1838), George Eliot’s Silas Marner (1861) and Wilkie Collins’s Poor Miss Finch (1872). Although each has received attention for its individual portrait of epilepsy, a comparative analysis enhances our understanding of progress in the knowledge about and treatment of the disease.
“Writhing and foaming” — Oliver Twist
The story of Edward Leeford, alias Monks, the title character’s villainous half-brother in Oliver Twist, renders a dramatic example of the stereotypes surrounding epilepsy before modern medicine. His “writhing and foaming”3 are mysterious and frightening both to other characters and to the reader, especially considering the way epilepsy was understood in 1837, when the first installment of Oliver Twist appeared in Bentley’s Miscellany.
At the time Dickens was writing, perceptions of epilepsy were so ill-informed by today’s standards that they were almost comic. The neurologist Edward Sieveking in 1858 summed up the ludicrous attempts at cures, writing: “There is scarcely a substance in the world capable of passing through the gullet of a man that has not at one time or another enjoyed the reputation of being anti-epileptic.”4 Seizures were often blamed on masturbation or the menstrual cycle.5
These notions were hardly new. Many ancient interpretations, as scholars have inferred from an ancient Acadian text, among other sources, depicted epilepsy as a sign from above—what the Hippocratic Corpus refers to as the “sacred disease.”6 The Hippocratic Corpus attempted to dispel this notion, but it persisted—along with superstitions that denigrated people with epilepsy as dangerous or malicious. In ancient Greece, spitting at people with epilepsy to “keep the demon away” was a customary practice.7 For some 2,000 years, this concept of epilepsy as a mysterious, evil product of the supernatural held strong. Dickens’ era was no exception.
Seizures are Monks’ defining characteristic, setting him apart as gruesome. The first time we meet him, he is memorable as the vilest thing in the “miserable abode” where a near-toothless woman has just starved to death in the dark.8 Hulking in the background for most of the scene, he draws attention to himself when he starts seizing: “He twined his hands in his hair; and, with a loud scream, rolled groveling upon the floor: his eyes fixed: and the foam gushing from his lips.”9 Like all of Monks’ “desperate fits,” this initial episode is prompted by emotional excitement.10 Because most of Monks’ strong emotions tend to be hateful, the fact that they provoke seizures reinforces the connection between the epilepsy and his corrupted inner life. As Eysell notes, in Oliver Twist, “Epilepsy is used in the traditional trope of manifest evil of the individual.”11 Just as Oliver’s angelic demeanor affirms for the reader that the little orphan boy is good, so too Dickens’ reader is prepared to believe Monks is a villain because he has epilepsy—a characterization essential for the social commentary in which the book is interested.
Notably, on the most basic level the outward manifestations of Monks’ seizures are faithful to the medical knowledge of the day. Although Dickens never specifically names the disorder (the word seizure appears only once in his entire body of work, in Bleak House12), there is evidence that he was well-informed about epilepsy. Despite contemporary claims to the contrary, it is unlikely that Dickens had the disease himself.13 He was, however, known to be friends with several doctors, and was acquainted with Thomas Wakley, the founder of The Lancet.14
Significantly, considering both the physiological accuracy of the seizures and Dickens’ probable awareness of the medicine of his day, nowhere does the narrative suggest that Monks might have a medical condition. Not once does someone who witnesses a seizure send for a doctor. Instead, bystanders back away in terror. As people had for centuries, these characters seem to believe that people with epilepsy need saving beyond what a physician can offer.
“A dead man come to life again” — Silas Marner
Two decades after the last installment of Oliver Twist appeared in print, the lonely epileptic weaver Silas Marner came to life on the page. Coincidentally published the same year as J. Russell Reynolds’ landmark neurology treatise, Epilepsy: Its symptoms, treatment and relation to other convulsive diseases, Silas Marner takes a surprisingly modern view of epilepsy. Cosslett notes that “George Eliot’s knowledge of and sympathy with Victorian scientific thought is well-known”15; her exposure to such scholarship included most notably her longtime live-in relationship with George Henry Lewes, an English philosopher whose later writing focused on science, particularly on motor and sensory nerves.16 In their home, Eliot and Lewes kept books and articles by Charles Darwin, and both the Irish natural philosopher John Tyndall and the English biologist Thomas Huxley visited them often.17
From the beginning, it is clear that Eliot’s narrator, at least, treats Silas Marner’s epilepsy as a medical condition. When, at a prayer meeting, Marner falls “into a mysterious rigidity and suspension of consciousness,” the narrator refers casually to the episode as a “cataleptic fit,” using the term for a catatonic seizure characterized by muscular rigidity.18, 19 As Wolf notes, “Epilepsy and catalepsy were not clearly separated in the minds of people in the early 19th century, and catalepsy may have been used as a diagnostic euphemism for epilepsy.”20
The characters, however, are less willing to accept a scientific justification for Marner’s seizures, attributing them to the supernatural instead. “In that far-off time superstition clung easily round every person or thing that was at all unwonted,” notes the narrator.21 The neighborhood people believe that Silas’ epilepsy should give him magical powers. Marner is viewed as a healer who “worked wonders with a bottle of brown waters” in a process with an “occult character.”22 One of Silas’ close friends describes his “trances” as looking “more like a visitation of Satan than a proof of divine favour.”23 Marner notices in his neighbors “something not unlike the feeling of primitive men, when they fled thus, in fear or in sullenness, from the face of an unpropitious deity.”24 Mr. Macey, the town parish cleric, “always said that when Silas Marner was in that strange trance of his, his soul went loose from his body.”25 In contrast to the narrator’s medically forward-thinking conception of epilepsy, the characters’ ideas fall in line with the long-standing concept of the “sacred disease.”
Having established this conflict between medicine and superstition, throughout the novel Eliot’s narrator gently but persistently insinuates that the townspeople’s assumptions are incorrect. “[F]ew men could be more harmless than poor Marner,” the narrator notes, a “truthful simple soul.”26 Suspicions that he has visions or magical powers, meanwhile, are “discouraged by the absence, on his part, of any spiritual vision during his outward trance.”27 Yet Eliot does not dismiss her characters. Instead, she explores the logic and assumptions behind their limitations.
In part, Silas Marner suggests, the people of Raveloe are unable to conceive of epilepsy as a medical condition because they are ill-informed. (“A fit was a stroke, wasn’t it?” the parish clerk asks.28) At other times, however, Eliot’s narrator suggests the characters are willfully ignorant: “Raveloe was a village where many of the old echoes lingered, undrowned by new voices.”29
The balance Eliot strikes between traditional and scientific understandings of epilepsy may have had particular relevance to her readers. At the time the novel was published in 1861, England’s long-held understanding of epilepsy was changing.30 Jackson’s discovery that a seizure was “an occasional, an excessive, and a disorderly discharge of nerve tissue on muscles” set off a chain reaction, as other neurologists built on his discovery to do their own groundbreaking research.31 The first major antiepileptic drug, bromide, was introduced in 1857.32 That same year, Sieveking presented a paper called “Analysis of 52 causes of epilepsy observed by the author,” in which he scrutinized the effectiveness of new medicines such as antimony, digitalis and silver nitrate.33
Many of the discoveries that were hailed as breakthroughs would be dismissed by researchers decades later. Nonetheless, for the first time, science was unseating superstition in the attempt to understand the causes of and treatment for epilepsy in the medical establishment, if not yet among the lay population.
Written as England was entering a new age of scientific modernity, Silas Marner advocates the questioning of the prevailing conception of epilepsy, just as scientists were doing. If Dickens was content to capitalize on the popular non-medical view of epilepsy to characterize his villain, Eliot charged her audience to be deeply skeptical. By the end of the novel, after the weaver has adopted a daughter and proved that he can have a place among the families of Raveloe, epilepsy and all, his neighbors undergo a conversion as far as his condition is concerned.
“’What is the treatment?’ ‘Medicine.’” — Poor Miss Finch
Wilkie Collins was fast friends with Charles Dickens for fifteen years—so close that he was an “honorary uncle” to Dickens’ children—but in his representation of epilepsy he could not have been more different.34 The notions of the disease that Dickens bolstered and Eliot questioned, Collins essentially avoided in a flying leap towards modern science.
Although historically critics have not talked about Collins in the same breath as canonical writers like Dickens and Eliot, the author’s work has been reclaimed of late.35Additionally, since, as we shall see, he engaged consciously with the scientific discourse of his day, and since his popular novels reached thousands of readers, Collins’s work is essential to our discussion.
In depicting his blue-skinned protagonist, Oscar Dubourg, Collins vividly imagines the struggles facing someone with epilepsy with an eye towards clinical realism well ahead of its time. “Collins’ medical research was thorough,” notes Catherine Peters; he read case reports as well as medical textbooks likely including the work of the British physician Thomas Watson.36
In the novel, Oscar, suitor to the lovely Lucilla Finch, gets hit on the head during a robbery and develops a condition that the narrative explicitly names as epilepsy. After the injury, “the next necessity was, of course, to send for the doctor,” whose words are “an indescribable relief”; this is among the first of many moments in which the text shows great respect for the medical establishment.37, 38
Of a piece with the novel’s serious treatment of medicine, Collins’ descriptions of seizures are highly accurate—not only symptomatically as in Oliver Twist, but also on the level of etiology. There is no question in this narrative that epilepsy is a medical disorder. When Oscar has his first seizure, “a frightful contortion fastened itself on Oscar’s face,” the narrator writes.39 “His eyes turned up hideously. From head to foot his whole body was wrenched round, as if giant hands had twisted it, towards the right. Before I could speak, he was in convulsions on the floor at his doctor’s feet.”40 These descriptions, Peters notes, “accurately describe focal, or partial epilepsy, typically caused by injury to the brain. … The blow to the left side of Oscar’s head produces a reaction on the opposite side of the body.”41 The doctor matter-of-factly describes the incident as “an epileptic fit,” and explains to Lucilla later that “the fits proceeded from a certain disordered condition of the brain.”42, 43 The narrator describes these as “nervous symptoms (to use the medical phrase).”44 When the narrator learns of Oscar’s epilepsy, she asks him, “What is the treatment?” His reply is simple: “Medicine.”45 These scenes contain not a whisper of the preternatural.
By the time Collins was writing, England was squarely in the age of modern epileptology that had begun with Jackson around 1865.46 Still, not everyone accepted epilepsy as a medical condition. An 1893 editorial in the London journal Medical Record noted that the general public believed all people with epilepsy to be insane (and pegged the real number somewhere around 10 percent).47
At a time when skepticism of the medical realities of epilepsy was still pervasive outside the hospital walls, then, the text’s clinical realism was sensational. A secondary impact, though, is to legitimize a new framework for epilepsy, pushing back against lay misconceptions. In depicting realistic characters responding to the disease with the medically appropriate action—the landlord riding off to fetch a doctor for Oscar, the patient himself seeking a second opinion—the narrative effectively reveals to readers the possibility of discarding superstition and embracing medicine.48, 49
Each of these three novels serves as a rich record of how epilepsy was viewed in a particular historical moment. In dramatizing the arc of conceptions of epilepsy in nineteenth century England, Oliver Twist, Silas Marner, and Poor Miss Finch also helped to chart that trajectory. Dickens essentially affirmed the existing perceptions of epilepsy and used those to attempt to change perspectives on social maladies. Eliot’s novel opened the way for debate, overtly criticizing ideas that would have been second nature to readers in an era when the medical establishment was moving too fast for the general population to keep up. Finally, Collins’ novel sought to legitimize a medical conception of epilepsy, basing an entire story on that assumption and urging action from that starting point. If Dickens reinforced the old worldview of epilepsy, Eliot queried it, and Collins refashioned it wholesale.
Even today, a potent quasi-Dickensian stigma still clings to epilepsy. “In spite of the panoply of 20th century technology and pharmacology,” D. Scott notes, “there are still areas in which knowledge has advanced little from the views, for example, of the 1st century BC or the mid-19th century physician.”50 Still, in reading these works we can see that gradual evolution did take place. In imagining epilepsy in vastly different ways, these three authors encouraged readers across generations to do the same, adding to the collective understanding of a disease which has, for millennia, captivated readers, authors, and their societies.
- Holmes, Oliver W. Medical Essays, 1842-1882. Edited by David Widger. Project Gutenberg. Accessed February 14, 2013. http://infomotions.com/etexts/gutenberg/dirs/2/7/0/2700/2700.htm.
- Temkin, Oswei. The Falling Sickness. (Baltimore: The Johns Hopkins Press, 1971), x.
- Dickens, Charles. Oliver Twist. Edited by Kathleen Tillotson. (New York: Oxford University Press, 1966), 217.
- Scott, Donald F. The History of Epileptic Therapy: An Account of How Medication Was Developed. (New York: Parthenon Publishing Group, 1993), 37.
- Scott, The History of Epileptic Therapy, 38-41.
- Temkin, The Falling Sickness, 3-4.
- Temkin, The Falling Sickness, 8.
- Dickens, Oliver Twist, 33.
- Dickens, Oliver Twist, 32.
- Dickens, Oliver Twist, 314.
- Eysell, Joanne. A Medical Companion to Dickens’s Fiction. (New York: Peter Lang, 2005), 217.
- Eysell, A Medical Companion to Dickens’s Fiction, 87.
- Hughes, John R. “Did All Those Famous People Really Have Epilepsy?” Epilepsy & Behavior 6, no. 2 (March 2005): 115-39. http://www.ncbi.nlm.nih.gov/pubmed/15710295.
- Eysell, A Medical Companion to Dickens’s Fiction, 12.
- Cosslett, Tess. The “Scientific Movement” and Victorian Literature. (New York: St. Martin’s Press, 1982), 74.
- Encyclopaedia Britannica Online, s.v. “George Henry Lewes,” accessed February 14, 2013, http://www.britannica.com/EBchecked/topic/338094/George-Henry-Lewes.
- Cosslett, The “Scientific Movement” and Victorian Literature, 74-75.
- Eliot, George. Silas Marner: The Weaver of Raveloe. (London: William Blackwood and Sons, 1861), 6.
- Eliot, Silas Marner, 7.
- Wolf, Peter. “Epilepsy and Catalepsy in Anglo-American Literature between Romanticism and Realism: Tennyson, Poe, Eliot and Collins.” Journal of the History of the Neurosciences: Basic and Clinical Perspectives 9, no. 3 (2000): 286-93. doi:10.1076/0964-704X(200012)9:3;1-A;FT286.
- Eliot, Silas Marner, 1.
- Eliot, Silas Marner, 14.
- Eliot, Silas Marner, 7.
- Eliot, Silas Marner, 12.
- Eliot, Silas Marner, 46-47.
- Eliot, Silas Marner, 35.
- Eliot, Silas Marner, 6.
- Eliot, Silas Marner, 4.
- Eliot, Silas Marner, 3.
- Scott, The History of Epileptic Therapy, 1.
- Encyclopaedia Britannica Online, s.v. “John Hughlings Jackson,” accessed February 14, 2013, http://www.britannica.com/EBchecked/topic/298832/John-Hughlings-Jackson.
- Scott, The History of Epileptic Therapy, 4.
- Scott, The History of Epileptic Therapy, 40.
- Pykett, Lyn. Wilkie Collins. (New York: Oxford University Press, 2005), 11-12.
- Pykett, Wilkie Collins, 216-221.
- Peters, Catherine. Introduction to Poor Miss Finch, by Wilkie Collins (Oxford: Oxford University Press, 1995), ix-xii.
- Collins, Wilkie. Poor Miss Finch. (CreateSpace Independent Publishing Platform, 2003), 86.
- Collins, Wilkie. Poor Miss Finch, 88.
- Collins, Wilkie. Poor Miss Finch, 97.
- Collins, Wilkie. Poor Miss Finch, 97.
- Peters, Introduction, xii.
- Collins, Wilkie. Poor Miss Finch, 97.
- Collins, Wilkie. Poor Miss Finch, 117.
- Collins, Wilkie. Poor Miss Finch, 96.
- Collins, Wilkie. Poor Miss Finch, 112.
- Friedlander, Walter J. The History of Modern Epilepsy: The Beginning, 1865-1914. (Westport, CT: Greenwood Press, 2001), 1-2.
- Friedlander, The History of Modern Epilepsy, 209.
- Collins, Wilkie. Poor Miss Finch, 86.
- Collins, Wilkie. Poor Miss Finch, 101.
- Scott, The History of Epileptic Therapy, 1.
LAURA FITZPATRICK is a rising second-year medical student and writer who lives in New York City. She writes Doctor-in-Training essays for Time.com, which chronicle her experiences at medical school. You can read more about her at www.laura-fitzpatrick.com.