Heredity in Ten Cases of Idiopathic Epilepsy, with Existing Disease or Cause of Death.

Sex. Paternal Ancestry. Maternal Ancestry. Brothers. Sisters. Remarks.
Father. Grand-
father.		 Uncles. Grand-
mother.		 Aunts. Mother. Grand-
mother.		 Uncles. Grand-
father.		 Aunts.
F. Died insane. Suicide; probably insane. Eccentric. . . . . . . Died of cerebral hemorrhage. Eccentric; died of cerebral hemorrhage. Drunkard. . . . . . . One a dipsomaniac; one in good health. One epileptic. A history of criminal proclivities.
M. Alive. Cerebral hemorrhages. Insane. . . . . . . Phthisis. . . . One died of phthisis. . . . Phthisis. One brother has infantile paralysis. Two sisters died of organic disease of the brain, one of cerebro-spinal sclerosis. Peculiar cranium.
F. Alive in third stage of post-sp. sclerosis. Phthisis. . . . . . . Phthisis. Alive. Not known. . . . Cerebral embolism. . . . One brother has infantile paralysis. . . .
M. Died of phthisis. Not known. Phthisis. . . . Epileptic. Migraine. Phthisis. . . . . . . . . . No brothers. No sisters.
M. Congestive headaches. Cerebral hemorrhage. Insane. . . . Migraine. Phthisis. . . . . . . . . . One died of phthsis; one hemiplegic. No brothers. No sisters. Peculiar cranium.
M. Alive. Insane. . . . . . . Insane. Phthisis. . . . Phthisis. . . . . . . Eight brothers and sisters. One died of epilepsy, and cerebral tumor was found; one paralyzed.
M. A confirmed drunkard. Died of embolism and softening at 76. . . . . . . Insane. Phthisis. Died in childbirth. . . . . . . Phthisis. . . . . . . Criminal proclivities.
M. Phthisis. Eccentric. One phthisis; one cerebral tumor. . . . . . . Migraine. . . . . . . . . . . . . One brother died of secondary tubercular meningitis, the other in an asylum. . . . Child of this parent was choreic.
M. A dipsomaniac and eccentric person. A genius. One died insane. Cerebral hemorrhage. None. Peculiar and eccentric. Migraine. Peculiar character. Insane and committed suicide. . . . Several brothers unaffected. No sisters. Criminal proclivities.
M. Most eccentric; a somnambulist. . . . . . . . . . Migraine. Epileptic. . . . . . . . . . Migraine. No brothers. No sisters.

In many idiopathic cases we find vices of cranial conformation, bodily asymmetry, and a history of early congenital syphilis. Laségue lays great stress upon cranial malformation, and goes so far as to say that all epilepsies not dependent upon some osseous trouble, either developmental or traumatic, are not epilepsies at all. Such epilepsy, which owes its origin to cranial asymmetry, rarely develops after the eighteenth year. The head is most often dolichocephalic or brachycephalic, and there is facial asymmetry. Laségue concludes that all the convulsions are identical; that it is not hereditary; that the attacks are always matutinal. It seems to me that Laségue's conclusions in regard to the non-existence of epilepsies from other causes are rather too arbitrary in view of the large amount of evidence to the contrary. In others, a very few, we find an apparent history of heredity explained by forceps-pressure during delivery.

So far as age and sex are concerned, and their predisposing influence, we find that by far the greatest number of cases begin before the twentieth year. This is the experience of Gowers, of Hammond, and of many others. Of my own 980 collected cases in which the beginning of the disease was known, there were—

Females.Males.Total.
Under 1010395198
Between 10 and 2017197268
Between 20 and 3014592237
Between 30 and 5081136217
Over 50 11 49 60
511469980

Of 1288 cases collected by nine French authorities, in 486, or over one-third, the disease began between the tenth and twentieth years. In Gowers's 1450 cases we find the following showing:

Cases.
Under 10422
From 10 to 19665
From 20 to 29224
From 30 to 3987
From 40 to 4931
From 50 to 5916
From 60 to 694
From 70 to 791

In 29 per cent. of these cases the disease therefore began before the tenth year.

As to sex, it appears that females are much more subject to the disease than males, but this is not true at any age. Epileptics under ten are more apt to be girls, but the proportion is nearly equal: between ten and twenty the proportion of females is undeniably greater. In adult cases we find that pure epilepsy (excluding hysteria) is much more often a disease of males than females.