THE EPILEPTIC CHILD

387

Moreover, 10 out of 12 bottles of the commercialextract were found to be contaminated by pathogenicorganisms ; and examples of serious reactions, leadingin one case to total blindness, in patients sensitised totheir own lens proteins by injections of either beef orjish-iens protein, were put before the committee.Breinin describes 3 cases, previously treated with theextract, which illustrate these dangers, and he emphasisesthe fact that the sensitising effects of fish -lens extractsmav mean that the cataract has to be extracted earlierand that the operation is more hazardous than usual.He thus supports the committee’s view that this treat-ment might seriously interfere with the surgical removalof the cataracts that it had failed to cure.In this country the claims for medical treatment of

cataract are generally restrained, and this particularlydangerous and unproved method has not, so far, beengiven much credence by the public. But notices of

Shropshire’s claims appeared in the lay press before theyhad been investigated by the medical profession, and the epublic is equally entitled to know of the findings of theAmerican committee.

6. Breinin, G. M. J. Amer. med. Ass. 1953, 152, 707.7. Medical Works of Hippocrates. Chadwick and Mann’s translation.

Cambridge; 1950, pp. 179-193.8. Ounsted, C. Proc. R. Soc. Med. 1952, 45, 865.9. Henderson, P. Brit. J. prev. soc. Med. 1953, 7, 9.

. THE EPILEPTIC CHILD

WHEN Hippocrates denied the sacredness of epilepsyhis aim was to bring epilepsy into the general body ofmedicine, and to bring the epileptic back into the generalbody of the community. But epilepsy, like madness,evokes both fear and awe : primitive peoples regard theepileptic as a person set apart by possession of a demonor a god ; and the wisdom of Hippocrates proved lesspotent than the old taboo. Apartheid for epileptics stillhas power today.Apartheid of any kind has two distinguiahing marks-

the isolation of the tainted group in special communitiesand the interdiction of marriage between tainted anduntainted persons. Procreation by epileptics was brutallysuppressed by the ancient Scots, and the milder Swedeshave since 1757 8 forbidden marriage to persons withidiopathic epilepsy. Hitler made similar laws, and in

England a tendency to recurrent attacks of epilepsy is aground for divorce. Taboo rather than reason seems tohave stimulated these laws, for the genetical pattern ofepilepsy is, to this day, extremely nebulous.The doctor who has to do with epileptics soon discovers

that ostracism is often responsible for character traitssometimes attributed to the disease. School teachers com-

monly show a surprising eagerness to eliminate affectedchildren from school, and even people with a medicaltraining may show disproportionate emotion when

tying to persuade a mother to send her epileptic childto a colony or home.

<

Much useful work has been done of late years in an

attempt to reintegrate the epileptic into the community,and England has a good record in this matter. Never-theless confusion remains, stemming from the tacit

assumption that the term " epileptic " adequatelydefines a socially homogeneous group. This is not thecase, For the purposes of upbringing, whether in schoolor at home, epileptic children fall into five broad groups :(1) those with normal intellectual, emotional, andphysical development ; (2) those with mild mental retard-ation, the educationally subnormal group ; (3) theineducable and the idiots ; (4) the psychotics ; and(5) those with an engrafted neurosis. Clearly our primeconcern should be with the mental status of the childrenrather than with their fits. Henderson 9 urges that theepileptic of normal mentality should lead a normal lifeboth at home and at school. An objection often raisedis that the sight of a child in a fit may upset other

children ; but Henderson shows that this objection haslittle substance, since only 9% of 365 epileptic childrenattending school were found to have had attacks in class.It would, ill any case, be more healthy to treat theoccurrence of a fit in school as an opportunity to teachchildren the value of calmness in the face of a medicalemergency&mdash;a useful in many a situation wheresyntax and the three Rs do not avail. Similarly, educa-tionally subnormal epileptics should be educated withother educationally subnormal children. (In practicemany of the inhabitants of epileptic colonies are placedthere not because of their fits but because of theirassociated retardation.)The idiots and the psychotics present the major

problem ; for their numbers are increasing as chemo-therapy and anticonvulsants prolong the lives of childrenwith gross hrain damage. The Sheffield branch of theSocialist Medical Association, in a useful little pamphletentitled The E1>ileptic,i&deg; suggest that institutional

placement is the appropriate method of disposal. Ismedical apartheid, then, perhaps necessary to this group ? gThe hyperl-dnetic psychotics raises the question at itsmost acute. These children, with their intense over-

activity, their ceaseless flitting about the house, and theirdestructive outbursts, reduce their homes and theirmotlers’ nerves to tatters with remarkable speed. Their

disposal, however, is seldom easy. Only exceptionalinstitutions can accept them, and such institutions areusually full. Even when a place is found, the parentswill, more often than not, refuse to let their child go.Though these children are, to the detached observer, theleast lovable of creatures, they nevertheless often evokein their parents a passion of self-sacrificing devotion thatoverrides both the normal fulfilments of family life andthe tidy plans of those who proffer help. Schemes whichwork with and through the devotion of the parents areunder trial already, and seem likely to prove both betterand cheaper than residential care. There will, however,no doubt remain for many years a group of epilepticchildren who must be placed in institutions, and it isour duty to see that such places are centres of livelyresearch and treatment rather than dumping-grounds.For thus we may hope to clear away some of that senseof fear and hopelessness which still accompanies thediagnosis of epilepsy.The parents of epileptic children are often difficult and

suspicious people, prone to seeking the second, third,fourth, and even the quack opinion. Their unreadinessto trust anyone was illustrated long ago when the fatherof an epileptic child said with tears : " Lord, I believe ;help thou mine unbelief." We were warned, on the sameoccasion, to expect no easy solutions.11

10. Obtainable from Dr. C. H. Foggitt, Church House, 754, AttercliffeRoad, Sheffield, 9. 1953. 6d. (plus postage).

11. New Testament, Authorised Version. St. Mark, 9, 16-29.

THE COST OF DISEASETHE 56th annual report of the King Edward’s Hospital

Fund for London says :" In its consideration of the wider aspects of hospital

accounting and statistics, the King’s Fund reviewed the

possibilities of ’ specialty’ costing in conjunction with depart-mental accounting and the use of medical and other recordsas the basic data upon which to calculate costs for the treat-ment of each main type of illness, disease, or operative treat-ment. At the present time no statistics are available showingthe cost to the country of treating cancer, rheumatism,tuberculosis, diabetes, etc. It is felt that if the cost of the

hospital service can be broken down’ to show informationof this kind it will be of greater national value than informa-tion on the amount of expenditure on salaries and wages, pro-visions, light, water, etc. The King’s Fund has carried outexperiments on these lines and interesting results have beenobtained. These are as yet by no means conclusive, butthey are of more than passing interest in that they indicatea constructive approach to the subject of hospital accountingin relation to the nation’s social needs."