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A century of prejudice and progress. A paradigm of epilepsy in a developing society Volume 3, issue 4, December 2001

Peter F. Bladin, Medical and Social Aspects, Victoria, Australia, 1835-1950.
Epilepsy Australia Ltd, Camberwell, Victoria, 2001; 259 p.

Melbourne and its suburbs (Heidelberg, for one) have become major neurological and epileptological centers, and Pr. Peter Bladin was instrumental in recent developments in these sciences in the new world "down under". This book is thus a reflection, by one of the major figures of modern epileptology, on the stumbling first steps of "epileptology", which became fashionable in the late XXth century but had to overcome hurdles told and untold. This "history of epilepsy" focuses on local issues, but readers will soon realize that it has universal significance. It is based on thorough research through many documents from the early australian history: this may appear as ancient history to some, as fairly recent events to others, with Old World sets of mind: however, all will agree that the amount of change that occurred over little more than a century is amazing, and needs to be properly recalled, lest we lose our consciousness of the transient nature of medical truths.

The state of Victoria was born in the 1830s, and its capital, Melbourne, derived from the first settlements around Port Philip, at the mouth of the Yarra river: this was grazing and farming land, until the famous "gold rush" of the 1850s, when the population rose suddenly from the hundreds to the tens of thousands. The establishment of the first Victorian (geographically and historically) structures of medical care is reported in the first chapters of this highly entertaining and readable volume. As heeded in the title, the developments then focus on the fate of the patients (who were victims to the time's prejudice against epilepsy) and on the progress of science.

Patients with epilepsy had nowhere to be kept but mental institutions (a progress over the prisons of still earlier days), and the author reports the case of such an institionalized young girl, who probably had juvenile myoclonic epilepsy. The mortality rate was high among "epileptics" in these institutions. The availability of effective drugs, starting with phenobarbital rather than with bromides, changed the attitudes somewhat, and the most striking event was the foundation in the early XXth century of an "epilepsy colony", the Talbot colony, which housed, in a farming atmosphere, up to about 200 long-term inpatients, and continued to function well after the second World War. It then progressively ceased to be a closed "colony" and became more like a rehabilitation centre. These are only details of a long and eventful history of the fate of Victorian patients.

Doctors did not have it easy, either. Some of the local medical societies were witness to important intellectual struggles, when younger physicians, fresh with their recent learning gathered abroad, especially in London, came back to enlighten their colleagues. The account of Dr James Springthorne's communication on his 21 cases of epilepsy makes great reading: it was actually a pretext for impressing upon the medical audience the latest concepts of H. Jackson, with whom he had worked in London. We learn from chapters concerned with more recent matters that there was no Australian branch of the ILAE before 1986...

The situation of patients and doctors in the state of Victoria, Australia, is certainly a paradigm of epilepsy with universal values, and this thoughtful, learned and documented rendition of all these years of progress and struggle will help the clinician of the present day see it all in perspective. The present state of our knowledge will probably appear wanting and incomplete to future historians, just as the discussions of our forefathers now sound to our modern ears. We can only hope that a kind, fairly objective and learned observer will examine and report our deeds - please, somebody like P. Bladin.

Pierre Genton

Books proposed for review can be addressed to the Supplement Editor: Dr Arzimanoglou A. Child Neurology Department, Hôpital Robert-Debré, 48, boulevard Sérurier, 75019 Paris, France.