ILAE History: The Second Period
The meeting of the International Neurological Congress and those particularly interested in epilepsy, was held on July 31, 1935 at the Lingfield colony in London. In the first issue of Volume 1 of the second series of Epilepsia, which appeared two years later, the editor H.I. Schou from Dianalund, Denmark writes:
"Thirty-two doctors representing 14 countries were present. After discussion it was unanimously decided that the ILAE should be revived. The immediate efforts should be directed towards improvement of the social condition and the institutional care of persons with epilepsy. To this end it was agreed that there should be a publication, issued annually or oftener, acquainting readers with facilities and with remedial efforts carried on in various countries. Plans were also laid for a meeting of the League at the time of the next Neurological Congress in Copenhagen."
At an adjourned meeting held on August 2, (Prof A. Ley of Brussels in the chair) the 1935-1939 Executive Committee was elected (appendix I).
"After the reorganization of the ILAE in London, 1935 the presidency decided also to reorganize the old periodical Epilepsia. It would, however, have to appear in a different form, for in the course of the past 20 years (1915-1935) neurological and psychiatric periodicals have appeared in so great a number that all scientific works on epilepsy and its treatment can be published there. The first aim of the reorganized League must, therefore, be the social care of epileptics and not so much scientific research into epilepsy. The new edition of Epilepsia must follow these lines. It must be an organ for our League. It will appear from the present first number that the organization of the League and the care of epileptics of the different countries for the time being occupy the space of the periodical, and for economical reasons it is intended to publish it once a year only. But if the economical means should be increased it will be published more frequently, and perhaps other subjects can be included, e.g., an annual "Index bibliographica epileptica" – The Editor."8
[NB: A review of the literature had been an important function of the first series and indeed in the second series this is taken up again from Volume 2 onwards and also maintained in the third series. The fourth series abandons this service to the reader, however, in March 19689 Epilepsy Abstracts is launched by the National Institute of Neurological Diseases and Blindness by its director Richard L. Masland and by the head section on epilepsy J. Kiffin Penry.]
This first issue of the second series of Epilepsia opens with a message from the president of the ILAE, Dr William Lennox:
"Viewed from any angle (medical, social or economic) the problem of epilepsy is a widespread and serious one. It has not yielded to individual efforts. A co-operative attack should give a larger hope of ultimate success. A co-operative group of workers such as comprise the ILAE, can forward the fight against epilepsy … "
In the next issue10 we are told that:
"In 1937 the ILAE has suffered the loss of one of its leading members, namely Dr L.J.J. Muskens, Amsterdam.
...It is with sadness that we publish on the next page this last article from Dr Muskens' hand. It was written at the request of the editor and sent to us shortly before the author's death."
This concerns11 'Short history of the first period of activity of the International League Against Epilepsy'.
The third International Congress of Neurologists was held in Copenhagen in August 1939. Schou in his capacity as secretary of the ILAE announced in Epilepsia12:
"On Thursday 24th of August a sectional meeting under this Congress will be held by the ILAE, and on Saturday the 26th of August -after the conclusion of the Congress- an excursion will be made to the Epileptics Hospital at Dianalund.
… There first will be a brief report on the work and the growth of the League, including the annual periodical Epilepsia, with the opportunity for discussion and criticism of the work hitherto performed and for making new suggestions. A constitution should then be presented for discussion and adaptation."
W.G. Lennox, being the president of the ILAE at that time, in a letter to the secretary13 suggested that:
"a special branch of the League, an association of laymen interested in epilepsy be formed. It is well known fact that in all civilized countries there is among laymen a growing interest in disease. Diseases as tuberculosis, cancer, rheumatism, syphilis, and, not least, the oriental infections, arouse the attention of the administration of the different countries, and national associations are formed in order to combat these diseases. It is possible too, that in all countries with a high standard of education there are so many intelligent epileptics that they will join our League Against Epilepsy. What is more natural than the idea that those who suffer from the disease themselves should be the most active in assisting the physicians in combating it? If we decide to admit laymen to the ILAE it can be effected in two ways. They may either be admitted as regular or as associate members and receive the existing periodical Epilepsia. Or there may be formed a special section for laymen who would get a special periodical on epilepsy, written in a popular form and adapted to laymen's knowledge. Much speaks in favour of adopting the latter procedure."
[NB: As will be described further down, it is not until 1966 that a sister organization for laymen's chapters is founded which is called the International Bureau for Epilepsy.]
At the business meeting the 1939-1946 Executive Committee was elected (appendix I) and the second constitution of the ILAE was ratified (appendix III).
In this constitution the objectives are described in article I as:
"to coordinate the activities of those who are interested in the better care and treatment of epileptics, and to stimulate interest in the social and scientific aspects of the disease."
To create special hospitals for people with epilepsy was an important issue right from the onset in 1909 through that period. Now there was also an emphasis on early treatment.
Special centres for epilepsy
In April 1940 there appears in Epilepsia14 a speech given by Schou when the representing members of the ILAE visited the Danish epilepsy centre Dianalund. In this he reported about the outcome of the questionnaire sent out in 1936 and published in Epilepsia in February 1937 enquiring about Institutions for Treatment of Epileptics in various countries. In that same 1937 issue the first replies from America, England and Scandinavia were published, also answers had been obtained from Germany (i.e., from Bielefeld in Westphalia and from Stetten and Württemberg). By 1940, replies had also been received from Holland, Switzerland, Czecho-Slovakia, India, Australia and South America. Further in his discourse he writes:
"Which are the requirements that must be made to institutions for epileptics in order that they may be called ideal institutions", and then: "How can our League Against Epilepsy further the establishment of such ideal institutions?"
From the several publications it appears that at that time it was considered that epileptic patients should have separate "clinics for epileptics", which concentrate only on epilepsy and are equipped, according to that point. The reasons given for the creation of such "clinics for epileptics", e.g., are voiced by H.P. Stubbe Teglbjaerg15 as follows:
- In ordinary neurological wards the epileptics will always constitute a minority and it cannot be expected that the staff will be able to spend sufficient time and energy on the solution of the problems displayed by the individual epileptic.
- The epileptic seizures will frequently be so great a trouble that the epileptics can not for longer period be in the same ward as other neurological patients, who frequently owing to their disease, just are highly sensitive.
- A regular repetition of the neurological examination, which will frequently be necessary in an epileptic, e.g., at some months' interval, cannot be carried through in a busy neurological ward, as not even a regular periodical summoning of the patient for renewed examination is sufficient to safeguard against surprises. In connection with an acute infection, a trauma, or spontaneously, epileptics who otherwise have not had any focal symptoms may, in the course of a few weeks or days, display signs e.g., of a tumour requiring rapid surgical interference. Therefore at least a systematized contact with the epileptic or the general practitioner treating him at home is necessary. Considering that about 50 per cent of all cases of cerebral tumour first manifest themselves through absences or seizures a close cooperation with a neuro-surgical ward is, of course, required but it may as well be secured from a hospital for epileptics as from a neurological ward.
Muskens16 suggests that there should be at least one colony per six to 10 million inhabitants, though he does not specify the size of these institutions. This trend is also reflected by statements of Schou.
"The ILAE congress should pass a resolution the aim of which should be to draw the attention of the authorities of the different countries towards the fact that epilepsy is a disease which must require the skilled examination of the patients right from the onset.
...Moreover such a resolution must draw the attention to the fact that in most countries there is too little hospital accommodation for clinical cases."
And indeed, there, in the same issue as his speech appears18 a
"RESOLUTION, adopted at the Meeting of the International League Against Epilepsy at Dianalund, Denmark, 26 Aug. 1939: The ILAE hereby heartily endorses the suggestions advanced by its executive secretary, Dr H.I. Schou, particularly those which call for the care of epileptic patients in hospitals which are equipped and staffed in such a manner that the causes of seizures in the individual patient may be properly diagnosed and appropriate treatment applied."
Epilepsia during World War II
The April 1940 issue was No. 4 and thus the last issue of Epilepsia, second series, Volume 1. Volume 2, second series, No. 1 appeared in July 1941 and opens with the statement:
"The Editor of the first four numbers of Epilepsia, second series, much regrets that the present conditions in Europe render it impossible to edit this issue of Epilepsia from Denmark. It is extremely difficult for persons in the various countries to communicate with each other, and the medical collaborators are largely occupied by other work. It was difficult to collect the material for Epilepsia No. 4, and it has proved impossible to edit the present number. All of us hope that these chaotic conditions are transient. We feel assured that the intellectual and scientific international collaboration will obtain another renaissance when the present crisis has passed away. Personally, I am grateful because Dr Lennox is willing to edit the present number of Epilepsia, the more so as much valuable work with the problems of epilepsy, both in scientific and social respects, are being carried on in America", signed: H.I. Schou.
Epilepsia, second series, achieves three complete volumes of one issue per year (1937-1948). The fourth volume, however, is interrupted after the second issue (1950). The name of H.I. Schou continues to appear as editor on the frontispiece of Epilepsia through the second series, Vol. 3, No. 2 (December 1946), in collaboration with Tylor Fox, England (Dennis Williams in 1946), William G. Lennox, Boston, and K.H. Stauder, Munich. However, these issues were in fact edited by W.G. Lennox (vide infra).
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