ILLINOIS. COMMISSION FOR HANDICAPPED 
CHILDREN 
THE EPILEPTIC CHILD IN ILLINOIS 1943 THE EPILEPTIC 
CHILD IN 
ILLINOIS 
Illinois, Commission for Handicapped Children 
June, 1943 STATE OF ILLINOIS 
Dwight H. Green, Governor 
Commission for Handicapped Children 
Mrs. Harry M. Mulberry, Chairman, Chicago 
IRVING F. Pearson, Vice-Chairman, Springfield 
Bert I. Beverly, M.D., Oak Park 
Rodney H. Brandon, Springfield 
Robert Bell Browne, Ph.D., Urbana 
Edward L. Compere, M.D., Chicago 
Roland R. Cross, M.D., Springfield 
Francis P. Murphy, Chicago 
Vernon L. Nickell, Springfield 
Frank A. Norris, M.D., Jacksonville 
Edward H. Stullken, Chicago 
Henry B. Thomas, M.D., Chicago 
Henry C. Warner, Dixon 
Lawrence J. Linck 
Executive Director 
211 West Wacker Drive 
Chicago TABLE OF CONTENTS 
PAGE 
Introduction 7 
Definition of the Problem 9 
Social and Economic Implications 12 
Extent of the Problem 16 
A State Program for Children with Convulsive Seizures.— 19 
Facilities in Illinois 3 1 
Unmet Needs in Illinois 33 
Recommendations — 35 
Bibliography 37 FOREWORD 
Among the duties charged to the Illinois Com- 
mission for Handicapped Children by the General 
Assembly is the promotion of special classes and com- 
petent individual instruction, adequate provisions for 
medical diagnosis and treatment, vocational training 
and placement, and social adjustment for all types of 
handicapped children in all parts of the State. 
The publication of this pamphlet is an attempt 
on the part of the Commission partially to fulfill that 
responsibility in respect to one group of handicapped 
children — those who are suffering from convulsive 
disorders and who are generally known as epileptic. 
It is an attempt briefly to set forth answers to some 
of the questions basic to action—What is epilepsy? 
How many epileptic children are there in Illinois? 
What is now being done and what needs to be done 
to relieve their condition and to equip them to lead 
lives as nearly normal as possible? 
The material set forth is directed toward a greater 
public understanding of the problems of these chil- 
dren. It is in no way intended as a technical study 
for medical specialists concerned with convulsive 
disorders. 
To Douglas Buchanan, M.D., of the University 
of Chicago, we extend our thanks for giving so gener- 
ously of his time and advice. Responsibility for in- 
adequacies in this paper rests with the Commission 
staff, however, not with Doctor Buchanan. 
Acknowledgment is also made to Miss Eveline E. 
Blumenthal, Social Research Analyst of our staff, who 
did the research and prepared the manuscript for this 
study. 
As it does with respect to its entire program, the 
Commission welcomes constructive criticism and com- 
ment on this publication. 
June, 1943 
Lawrence J. Linck 
Executive Director INTRODUCTION 
Convulsive seizures are one of the oldest of 
known human disorders. In ancient times those 
afflicted were thought to have been possessed by 
demons, and were shunned with horror. Until the 
last century, these unfortunates were subjected to 
every imaginable type of treatment, varying from the 
practice of boring holes in their skulls to permit ‘‘evil 
spirits" to escape, to use of the most unpalatable so- 
called curatives. It has been observed that ‘‘in fact, 
there is not a substance in the world, capable of pass- 
ing through the gullet of man, that has not at one 
time or other enjoyed a reputation of being an anti- 
epileptic."1 Remedies included such prescriptions as 
swallowing twenty-one houseflies in a liquid medium; 
solution of burnt pig's bones; claws of a lynx; nail 
parings; ashes of a pulverized toad; vulture liver; 
mummy dust; and many other such concoctions.2 
Throughout history, human blood was deemed to 
be especially efficacious, and sufferers from convulsions 
habitually frequented the battleground of dying 
gladiators and the execution places of persons con- 
demned to die by the guillotine or the ax, to fight for 
the privilege of drinking fresh human blood. 
With such a background of superstition, horror, 
and ignorance, it is little wonder that a stigma was 
attached to the disorder which has lasted up to the 
present day. 
1 Quoted from Sieveking by Leo Kanner in “The Folklore and Cultural History of 
Epilepsy,” Med. Life, 37 (April, 1930), 181. 
3 Ibid., pp. 181 S. DEFINITION OF THE PROBLEM 
In the last two decades, older concepts of the 
nature and origin of these paroxysms have crumbled 
under the discoveries and contributions of neuro- 
pathologists, neuro-surgeons, biochemists, physiolo- 
gists, and physicians, who now consider these seizures 
to be not a disease, but a symptom of underlying 
pathology. Convulsive seizures are so infinitely 
variable in character and incidence and generally so 
hidden in origin that they have defied attempts at 
definition. Because of this, the name “epilepsy" is 
considered by many authorities to be an inaccurate and 
undesirable term. It has been suggested that “parox- 
ysmal disorders," “convulsive state," or “convulsive 
seizures," be used instead. 
There are two generally recognized forms of at- 
tack, with rather well defined clinical symptoms: 
major seizures and minor seizures. The variations 
in type and combinations of symptoms are so great 
that no attempt will be made here to include a com- 
plete description.1 
Major seizures are characterized by sudden and 
complete loss of consciousness and severe convulsions 
which consist of powerful muscular spasms which are 
at first rigid and then clonic, or shock-like in character. 
A post-seizure period of heavy sleep usually follows. 
In approximately 50 per cent of the cases, an aura, or 
warning, precedes the seizure, and there may be out- 
ward symptoms or signs occurring hours or days be- 
1A classic discussion of the nature and symptoms of paroxysmal disorders may be found 
in S. A. Kinnicr Wilson’s Neurology, ed. by A. Ninian Bruce (Baltimore: Williams if 
Wilkins, 1940), II, 1469-1 544, chap. 26, ‘‘The Epilepsies.” fore the onset of the spasm. The seizure itself may 
last for only a few minutes or for a half-hour or 
longer. Headaches, vomiting, or muscle soreness may 
follow. 
Minor seizures consist of transient episodes of 
unconsciousness, with convulsive movements, if any, 
usually confined to slight twitching of the face or 
eyelids, or to a nodding movement of the head. Ac- 
cording to Merritt, the “degree of loss of consciousness 
may vary from a complete amnesia for a minute or 
more to a second of partial retardation of activity of 
higher cerebral centers which can be detected only by 
special methods.”1 It is because of the frequent ab- 
sence of outward symptoms and the rapid regaining 
of the faculties that minor seizures are often unrecog- 
nized as convulsions. A blank stare, a slight swaying 
of the body, cessation of conversation, or relaxation 
of the grip may be the only outward sign. Such at- 
tacks are often described as “thinking spells” in chil- 
dren. Although this transient mental absence may be 
so fleeting in itself that it is undetected, a prolonged 
state of confusion may follow. According to Wilson, 
symptoms may ensue whose complexity or length is 
altogether disproportionate to the preceding functional 
disorder. The importance of this cannot be stressed too 
much, for the true character of minor fits is often not 
realized until a major attack takes place or unless recurring 
peculiarities of behavior on the patient's part compel 
attention.2 
Minor seizures are more commonly seen in child- 
hood than in later life, and occur with much greater 
frequency than do major convulsions. 
In summary, to quote Cobb and Lennox, con- 
vulsive fits 
1H. Houston Merritt, “The Treatment of Epilepsy,” Med. Clin, of N. A., XXV 
(Philadelphia, W. B. Saunders Co., September, 1941), p. 1332. 
■Wilson, op. cit., pp. 148 5-8 6. consist of the sudden and repeated appearance of seizures, 
of which disturbances of consciousness, convulsive move- 
ments, or both are the principal element. The term 
seizure covers various manifestations, which patients may 
exhibit; convulsions . . ., transient losses of con- 
sciousness . . periods of mental confusion, dreamy 
states, dizziness, or the performance of automatic acts of 
which the patient afterwards has no recollection (equiva- 
lent with amnesia) are some of the more usual types, 
but the symptomatology is infinitely variable. In general, 
any patient who has recurrent seizures is called epileptic.1 
No feature is constant, according to Wilson, the least 
mutable being “sudden onset, brief duration, and 
recurring habit.’’2 
A simple and descriptive clinical definition is that 
offered by Merritt, who says, “Epilepsy is a term used 
to describe a wide variety of abnormalities of con- 
sciousness with or without convulsive movements.’’3 
1 Stanley Cobb and Wm. G. Lennox, “Epilepsy,” Diseases of the Nervous System, Oxford 
Medicine, VI (New York: Oxford University Press, 1941), p. 893-4. 
2 Wilson, op. cit., p. 1470. 
3 Merritt, op. cit., p. 1331. SOCIAL AND ECONOMIC IMPLICATIONS 
Because of the unfortunate and unnecessary 
stigma attached to the convulsive disorders, social 
implications of the problem are immeasurably in- 
creased, and the implementation of any treatment pro- 
gram made much more difficult. Persons so handi- 
capped are shunned and excluded from participation 
in community life and frequently are prevented from 
attending school regularly. They are advised not to 
marry for fear of transmitting their disability to their 
children.1 Vocational opportunities are limited, be- 
cause of the necessity of avoiding hazardous situations 
and because most employers will not accept them be- 
cause of employer-liability in case of injury while 
at work. 
The cost to society is heavy. There are ap- 
proximately 30,000 epileptics in various state insti- 
tutions in the forty-eight states.2 But even greater 
than the institutional cost is the economic loss with 
respect to the large majority who are not receiving 
institutional care. Because a large proportion of these 
are reduced to economic unproductivity, the total 
direct annual cost has been estimated by one authority 
to reach an aggregate of $ 100,000,000.3 
1 According to studies made at the Harvard University Medical School, “the hereditary 
factor, although not as great as is popularly supposed, is important. . . . Much con- 
fusion of thought has resulted from a tendency to consider only persons with an actual defect 
and to disregard the far greater numbers of carriers of this defect. It would seem that 
epilepsy is hereditary in the same manner as other morbid conditions, for example, cancer 
or kidney disease. The ‘constitution’ or susceptibility is present in all who develop the 
condition, but whether seizures actually appear may depend on fortuitous contributing causes. 
The susceptibility may be so strong in one individual that little or no apparent cause is 
needed to ‘set off' an attack, or so weak in another that attacks begin only after severe 
stimuli. The most important associated causes arc injuries to the central nervous system.” 
(Cobb and Lennox, op. cit., pp. 902-903.) 
2 Albert Deutscb, The Mentally III in America (New York: Doublcday, Doran 8 Co., 
1938), p. 383. 
3 Wm. G. Lennox, Science and Seizures (New York: Harper Bros., 1941), p. 56. Much has been written about the “epileptic per- 
sonality” which has been discredited in the light of 
modern studies of mental, emotional, and personality 
growth. Convulsions, like any other disability tend- 
ing to isolate an individual or make him dependent 
or conspicuous, will react unfavorably on personality 
development. Suffering ostracism both socially and 
vocationally, he may become self-conscious and dis- 
couraged. Anxiety, based on fear of seizures, may 
increase his lack of adjustment. It has been stated 
that the egoism, instability and hypochondriasis com- 
monly attributed to those having convulsive seizures 
are symptoms to be found in any chronic invalid, and 
“may be the results of invalidism and discourage- 
ment.”1 
With the exception of mental defectives and those 
whose handicaps were caused by injury or disease of 
the central nervous system, there is no specific group 
of the physically or mentally handicapped in which 
more persons having convulsive seizures may be found 
than in the general population. 
Because most of the statistical information which 
has been released on seizures has been based on research 
among institutional patients, it is unreliable when 
applied to extra-mural patients. The general belief 
that mental deterioration inevitably results from con- 
vulsive attacks can be disproved. Lennox, speaking 
from the viewpoint of statistics on almost 2,000 
extra-institutional patients, states that although con- 
genital mental defect and heredity of seizures are 
linked, and twice as many mental defectives have 
seizures as do mentally normal persons,2 yet the great 
1 Cobb and Lennox, op. cit., p. 900. 
2 Lennox, op. cit., p. 51. majority suffer no mental impairment. For instance, 
of 1,905 patients on whom information had been 
secured from neurologists throughout the country, 
2 per cent were superior mentally, 62 per cent were 
normal, 22 per cent were slightly subnormal, 12 per 
cent definitely deteriorated, and 2 per cent markedly 
deteriorated.1 Of those considered mentally normal 
at birth, 75.4 per cent were mentally normal, and an 
approximately equal percentage (76.4) of those who 
had suffered no cerebral trauma prior to the onset of 
seizures, were normal. The average patient in this 
group had had 2,000 seizures over a period of eight 
years.2 These data compare favorably with the White 
House Conference estimates of 1 per cent markedly 
defective and 14 per cent subnormal in the general 
population.3 
Sullivan and Gahagan, in a study of 103 chil- 
dren admitted to the Los Angeles Children’s Hospital 
for treatment for convulsions, found that 24.2 per 
cent were borderline or feeble-minded (having an I.Q. 
below 90), as against a percentage of 15.7 for the 
Los Angeles City Schools.4 
It may be seen, then, that mental deterioration 
in this disorder is greatly overemphasized. In general, 
mental impairment may be due to any of the follow- 
ing causes: (1) congenital defect; (2) cerebral 
trauma; (3) great frequency of attacks; (4) uncon- 
trolled medical treatment, which is especially danger- 
1 William G. Lennox, “Mental Defect in Epilepsy and the Influence of Heredity,” 
Am. J. Psychiat., 98 (Match, 1942), 734. 
2 Ibid., p. 73 5. 
8 White House Conference on Child Health and Protection, Section III, The Handicapped; 
Prevention, Maintenance, Protection (New York: Century Co., 1933), p. 334. 
4 Ellen B. Sullivan and Lawrence Gahagan, “On Intelligence of Epileptic Children,” 
Gen. Psych. Monographs, 17 (October, 1935), 33 7. ous when purchased by mail; and (5) discourage 
ment, resignation, and lack of initiative.1 
The fact of living under constant threat of convulsions 
is manifestly a heavy psychologic burden. It is apt to 
result in emotional tensions and to lead to a feeling of 
hopelessness which tinges intellectual processes and ren- 
ders concentration difficult. ... If myriads of brief 
“absences” of consciousness occur several times over sub- 
stantial periods, their effect may be crippling to any com- 
plicated form of mental activity.2 
1 Lennox, Science and Seizures, p. 51. 
3 I. Putnam Tracy and H. Houston Merritt, “Dullness as an Epileptic Equivalent,” 
Arch. Near, and Psychiat., 45 (May, 1941), 798. EXTENT OF THE PROBLEM 
No general census of the number of persons hav- 
ing seizures is available either for the United States 
or any other country. Because of the very nature of 
the problem, it does not lend itself readily to sta- 
tistical study. Its occurrence is many times concealed 
for fear of social stigma. A large number suffering 
from the disorder do not seek medical treatment be- 
cause of their belief that they are incurable. Or, the 
seizures may be so fleeting or mild in nature that their 
true nature remains unrecognized. For these reasons, 
most estimates made as to the extent of incidence of 
convulsive seizures are much too low. 
During the first World War, examinations given 
to 2,500,000 men provided a basis for the first ex- 
tensive estimate. Since diagnosis was made upon the 
basis of a volunteered history of childhood convul- 
sions, however, cases in which this was unknown or 
concealed were not included and the disorder became 
apparent only when a seizure occurred after induction 
into service. Of the total number, 5.15 per 1,000 
gave such histories. Admissions to sick reports be- 
cause of seizures after entrance into service were 2.09 
per 1,000 for whites and 7.23 for colored in 1918, 
and 2.70 for whites and 6.54 for colored in 1917. 
Total admissions to sick reports in 1917 for the 
United States, Europe, and all other countries were 
2.70 for whites and 5.23 for colored.1 
1 Quoted from reports of the Surgeon General of the U. S. Army, by Charles B. 
Davenport, "Racial and Geographical Distribution of Epilepsy,” Epilepsy and the Convulsive 
State, Vol. VII of Research Publications of The Association for Research in Nervous and 
Mental Diseases (Baltimore: Williams S3 Wilkins, 1931), p. 121. These racial differences 
have not been borne out in further research. Because convulsive seizures are predominantly a 
disorder of childhood and adolescence, the rate of 5.15 
per 1,000 for drafted men is too low for valid appli- 
cation to the child population of the country. Almost 
one-half of all persons admitted to institutions for 
convulsions are under twenty. The White House 
Conference report, recognizing the difficulty of proper 
weighting, nevertheless proposes an estimate of 8.0 or 
9.0 per 1,000 for the total population under twenty,1 
which, on the basis of the 1940 census would mean 
that there were between 380,000 and 430,000 epi- 
leptics in this age group in the United States. 
Although great regional variations in the draft 
figures led to doubts as to their validity, the estimate 
has been corroborated in subsequent studies elsewhere. 
In an inquiry into the histories of 1,000 medical stu- 
dents and nurses conducted by Lennox of Harvard 
University Medical School, a rate of 5 per 1,000 was 
discovered, 1 out of every 200 having a history of 
seizures in their families.2 This, he notes, is approxi- 
mately the same number as those having active tuber- 
culosis or diabetes. 
A house-to-house canvass conducted as part of 
the Texas Child Welfare Survey disclosed a rate of 
2 per 1,000 among children less than nineteen years 
of age,3 a figure identical with that estimated by the 
Board of Education of the City of New York in 
193 6,4 and that resulting from an extensive study of 
nine northern Michigan counties in 1933, covering a 
population of 73,056.5 Closely approximating these 
is the estimate of 2.29 per 1,000 estimated in a study 
1 White House Conference on Child Health and Protection, op. cit., p. 292. 
2 Lennox, Science and Seizures, p. 21. 
9 Texas’ Children, The Report of the Texas Child Welfare Survey, University of Texas 
Publication 3837 (Austin: Univ. of Texas, 1938), p. 76. 
* Epileptic Children, Board of Education, The City of New York, Committee for the 
Study of Care and Education of Physically Handicapped Children in the Public Schools of 
the City of New York (New York: Board of Education, 1941), p. 3 5. 
3 C. L. Anderson. “Epilepsy in the State of Michigan,” Ment. Hyg., 20 (July, 193 6), 
458. of the incidence of convulsive seizures in the Eastern 
Health District of Baltimore in 1936, covering a 
population of 55,000. In this study, all doubtful 
cases were excluded.1 
Undoubtedly, in all of these cases, the inclusion 
of unrecognized or marginal types of seizures would 
make the rate higher. As the New York report stated: 
“It is not necessary to demonstrate by statistics the 
well-known tendency of people to minimize symp- 
toms or disability if knowledge of them were to result 
in deprival of privileges or to be contrary to their 
interests.”2 
The only inquiry directed toward discovery of 
the extent of the problem in Illinois was the cursory 
survey made by senatorial districts in 1912 by the 
Committee of Fifty. This committee, formed for the 
purpose of securing establishment of a colony for this 
group of handicapped in Illinois, estimated that one 
out of every 500 was subject to seizures,8 observing 
that this was a conservative estimate and undoubtedly 
an under-statement of the real seriousness of the prob- 
lem. The estimate does agree, however, with those 
given in the other studies cited. 
Thus, since the 1940 Federal census lists, 1,968,- 
335 children in Illinois between the ages of five and 
twenty-one, estimates as to the number having seiz- 
ures would range from 4,000 according to the lowest 
rate (2 per 1,000) to 18,000 on the basis of the 
highest rate (9 per 1,000). 
1 Paul Lemkau, Christopher Tietzc, and Marcia Cooper, “Mental Hygiene Problems in 
an Urban District,” Merit. Hyg., 26, (April, 1942), 280. 
a Epileptic Children, pp. 35-36. 
3 How the Uncared-for Epileptic Fates in Illinois. Report of the Committee of 50 
(1912), p. 28. A STATE PROGRAM FOR CHILDREN WITH 
CONVULSIVE SEIZURES 
A state program designed to meet the medical, 
social, and educational problems of the child subject 
to seizures would, in light of the picture here pre- 
sented, involve three major phases: (1) treatment, 
(2) public education, and (3) research. The treat- 
ment program, although inseparable from the other 
two phases, would have the following significant 
factors: identification and diagnosis, medical super- 
vision and treatment, colony and nursing-home care, 
aftercare, educational provisions, and vocational guid- 
ance, training, and placement. 
Identification and diagnosis Thousands of dol- 
lars could be saved annually by the State if an 
effective program of early case-finding and treatment 
were established. This would depend upon the earn- 
est coordination of the facilities of all schools, health 
and welfare agencies, county physicians’ organizations, 
public health services, children’s agencies, and parents 
and relatives. Thus the program would be inextri- 
cably bound up with that of public education, to 
create a realization of the extreme urgency of recog- 
nizing the disorder early in life and having treatment 
instituted at the earliest possible moment. This is 
important not only with respect to remedial efforts 
medically, but also to prevent development of per- 
sonality difficulties. The importance of early diag- 
nosis cannot be stressed too greatly, since authorities 
agree that chronic convulsions are frequently the result 
of habit formation, through repetition of the seizures 
and weakening of resistance. Gowers has called it a “self-perpetuating” disorder.1 Parents who believe 
that children will “outgrow” convulsions or seizures 
are only furthering the gravity of the disorder by 
waiting until some abnormality appears before start- 
ing treatment. As Thom says: 
There seems to be little doubt in the minds of those 
most interested in the subject of epilepsy that each con- 
vulsion paves the way for the succeeding one and that 
the path becomes deeper and the demarcation sharper and 
more easily traversed. . . . For this reason it is tre- 
mendously important for the future welfare of the child 
that every investigation be made, by both clinical examina- 
tion and laboratory tests, to determine the exciting factor 
in the production of these infantile convulsions.2 
Especially important is early recognition and 
treatment of minor seizures, which are so often over- 
looked, but which may be present for years before an 
overt convulsion occurs. From 70 to 80 per cent of 
cases show the onset before the age of twenty, accord- 
ing to varying estimates, the two most dangerous 
periods being the first two years of life and the 
adolescent period.3 
Finally, early diagnosis is essential in cases in 
which the seizures are precipitated by brain injury, 
brain tumor, or other lesions which might possibly 
be remedied by surgery. 
Medical supervision and treatment No state has 
a program for treatment of persons suffering from 
convulsive seizures whose condition is not so serious 
as to require custodial care. Only ten states have spe- 
cial institutions or colonies.4 Of the 30,000 who are 
1L. J. J. Mnskens, Epilepsy; Comparative Pathogenesis, Symptoms, Treatment (New 
York: Wm. Wood 8 Co., 1928), p. 335. 
2 Study by Pigott, Wcingrow and Fitch, quoted by Douglas A. Thom, “Convulsions 
of Early Life and Their Relation to the Chronic Convulsive Disorders and Mental Defect,” 
Am. J. Psychiat., 98 (January, 1942), 573. 
3 Lennox, Science and Seizures, p. 38. 
4 These arc: Indiana, Kansas, Massachusetts, Michigan, Minnesota, New Jersey, New 
York, Ohio, Pennsylvania, and Texas. (Hospital Service in the United States, 1943, 
reprint of J. Amet. Med. Assn., March 27, 1943.) Institutionalization will not be fully dis- 
cussed here, since this survey is directed mainly toward care of those who are adjustable to com- 
munity life. In general, commitment is recommended only in cases of severe mental de- 
terioration: if attacks are frquent and violent and uncontrollable by medication; if constant 
attention is required, or the welfare of other members of the family otherwise jeopardized. now institutionalized, only one-third are in special 
hospitals. The remainder are housed in various state 
and private institutions for the mentally diseased and 
the mentally defective, or penal and correctional insti- 
tutions. This general lack of a definite program and 
tendency to use any and all facilities available has pro- 
duced a chaotic situation, and has furthered the stigma 
with which the disorder is associated. An adequate 
program of medical care would envision three types 
of service: hospital care, home care, and custodial care, 
all based upon continuing and intensive research. 
According to Shou, about 50 per cent of those having 
convulsions can become wholly or partially free from 
seizures with hospital treatment.1 
Aftercare of patients should be in colonies for 
those who do not respond to treatment, and in nurs- 
ing-homes for those who need further hospital care 
or who need close supervision because of frequent or 
severe seizures. A family placement program is an 
essential resource for those whose return to the envi- 
ronment from which they came would be damaging. 
Follow-up service, both with respect to medical care 
and social adjustment, is vital, in order that the physi- 
cian have assurance that his recommendations are 
being followed carefully, and the family and child 
given the benefit of guidance in educational, recrea- 
tional, and vocational planning. 
Outpatient centers established throughout the 
state would serve many urgent needs, such as super- 
vising the training of children who have convulsions 
and are mentally normal, instructing persons having 
the care of those living at home, training field workers, 
and stimulating the interest of lay and professional 
1H. I. Sbon, “The Ideal Organization of the Treatment and Care of Epileptics,* 
Epilepsia, 2nd ser. I (May, 1938), 99. persons who would be instrumental in effectively in- 
terpreting the nature of the disorder to the public. 
Two European countries, Holland and Den- 
mark, have had excellent systems of care. Holland had 
two large central hospitals and a third under con- 
struction at the time of the Nazi invasion. In addi- 
tion, ten consultation offices and three polyclinics were 
established in different parts of the country, staffed 
by central hospital doctors, who supervised former 
patients and admitted new ones. Two institutes for 
treatment were maintained, and two special schools 
for mentally normal children excluded from regular 
schools because of seizures. A. visiting nurse system 
was in operation for aftercare. One of the chief fea- 
tures of the program was a nation-wide propaganda 
association, with a membership of 100,000 persons, 
the income from their dues providing for the care of 
indigent patients, and for the promotion of public 
education. Branches of this association were estab- 
lished in every town in Holland.1 
Denmark had a central hospital solely for adults, 
with an elaborately equipped laboratory for research. 
Different types of cases were segregated and special 
wards maintained for those who were psychotic. In 
addition, there was a special hospital for children be- 
tween the ages of one and fifteen, with facilities for 
segregating new from chronic cases. Only children 
of normal mentality were accepted. Affiliated with 
the children's hospital were two homes, one for boys 
and one for girls, where they received schooling while 
under treatment. Family care was provided for those 
patients for whom it was recommended, through ar- 
rangements between the hospitals and 150 private 
1B. Ch. Ledeboor, “Cate for Epileptics in Holland.” Epilepsia, 2nd set. I (April, 
1940), 268-80; see also H. I. Schou, “Institutional Care of Epileptics in Different Coun- 
tries of the World,” Ibid., pp. 252-60. families who co-operated in the treatment program. 
Nursing homes were established throughout the coun- 
try, affiliated with the hospital. The Danish system 
was entirely state-supported, with the exception of 
the hospitals, which were private.1 
Therapy in convulsive disorders is based upon 
medical treatment, supplemented by every possible 
means to promote the physical and mental hygiene of 
the patient, through diet control, moderate exercise, 
good posture and circulation, and avoidance of emo- 
tional strain. Operations for removal of adhesions, 
scar tissue, tumors, etc., when indicated, are effective 
in cessation of seizures in only one-half of the cases 
in which they are resorted to.2 No medicine is specific 
as a curative, but three are now in general use for con- 
trol for seizures — diphenol hydantoin (Dilantin), 
phenobarbital (Luminal), and bromide. Dangerous 
toxic effects may result from the misuse of each of 
them, necessitating careful supervision by competent 
physicians in their prescription. Dilantin, introduced 
by Putnam and Merritt of Boston in 1938, has proved 
remarkably effective, bringing complete relief from 
seizures in approximately 50 per cent of cases, and a 
marked reduction of symptoms in many more,3 in 
addition to effecting a marked increase in mental alert- 
ness and clarity. 
Advertised cures are especially dangerous, since 
there is no means to prescribe the correct medicine or 
the proper dosage, or to determine possible idiosyn- 
crasy by the individual to the given treatment. 
The lay person, in handling a child during a 
paroxysm, can do little except to loosen tight cloth- 
ing, taking steps to prevent physical injury, and plac- 
1 H. I. Schou, “The Ideal Organization, etc.” op. cit., pp. 102 ff. 
3 Wilder Pcnfield and Theodore C. Erickson, Epilepsy and Cerebral Localization (Balti- 
more: Charles C. Thomas, 1941). 
3 Merritt, “The Treatment of Epilepsy,” op. cit., pp. 1331-46. ing a semi-hard object between the teeth to prevent 
tongue biting. The child should be permitted to 
sleep after the spasm has run its course. 
Educational provisions The average child sub- 
ject to seizures is not in need of special educational 
provisions, and if mentally normal, should take his 
place in regular classes, if his seizures are not so fre- 
quent and severe as to disrupt the classroom or inca- 
pacitate him from learning, or if he is not too much 
of a behavior problem. Since from 60 to 80 per cent 
of epileptics are considered to be mentally normal, 
adequate educational provisions assume great impor- 
tance in light of the fact that stimulation of intel- 
lectual interests is a major phase of any treatment 
program. If the child is mentally retarded, placement 
in an ungraded class may be necessary. Otherwise, 
only slight modification of the curriculum is required. 
Michigan is the only state allocating funds for excess 
costs of educating children with convulsive seizures 
who “cannot profitably or safely be educated by the 
usual methods of instruction in the public schools,” 
granting $200 per pupil.1 
Whether the child is receiving regular or special 
class instruction, or home teaching, provision should 
be made for referral of all cases to a physician or clinic. 
This involves the sometimes difficult task of inter- 
preting the situation to the parents and securing their 
co-operation, and necessitates the active and continu- 
ous service of a school nurse or public health nurse in 
follow-up care. It is also important that the child's 
problems be interpreted to his teachers and fellow 
pupils so that he may have their acceptance and sym- 
pathetic understanding. Although the school does 
1 Elisc H. Martens, State Supervisory Programs for the Education of Exceptional Chil- 
dren, Bull. 1940, No. 6, Monograph No. 10, Office of Education, Federal Security Agency 
(Washington: Gov’t Printing Office, 1941), p. 43. not assume responsibility for treatment, it could play 
a guiding role in the integration of services of the 
school physician, public health nurse, family physi- 
cian, and parents. This would help to prevent the 
tragic loss resulting from the withdrawal of these chil- 
dren from school, leaving them to drift aimlessly and 
untrained into a fruitless, dependent existence. 
The mental health aspects of the problem of con- 
vulsive seizures should receive particular attention, to 
avoid the social isolation and intellectual stagnation 
which so often result. In this regard, psychiatric care 
and social service study are indispensable. The fear, 
uncertainty and anxiety of those handling a child so 
handicapped are easily transmitted to him, and chances 
of recovery are seriously jeopardized by over-solicitude 
and over-protection. The child guidance clinic should 
have a guiding role with the school in conducting this 
phase of the program. 
For those who must be excluded from regular 
classes but can profit by individual instruction, vari- 
ous adaptations should be made within the frame- 
work of the educational system. The following are 
plans which have been put into operation elsewhere 
in the United States. 
1) Combination of medical, educational, and 
social planning. This is a special school plan which 
is feasible only for the more thickly populated centers. 
Detroit, which is the only city in the United States 
which has developed a special school for children with 
convulsive seizures, opened White Special School in 
19341 as a part-time boarding school giving full care 
to the pupils five days a week, for children whose 
seizures occurred during school hours. The board- 
ing-care aspects were later eliminated and transporta- 
1 Education of the Handicapped in Detroit Public Schools (Detroit: Board of Educa- 
tion. 1937), pp. 37-39. tion provided for all in attendance. Each child 
receives the benefit of intensive study and individual 
supervision and therapy, through the cooperation of 
the medical college of Wayne University. Once a 
week a clinic is conducted for examination and 
diagnosis of new “candidates,” referred by the social 
service department of the Psychological Clinic. Each 
child is re-examined regularly. The curriculum 
is flexible, with particular stress being laid on voca- 
tional guidance and training. The Department of 
Special Education assumes responsibility for the edu- 
cational, vocational, and social-adjustment phases of 
the program. The program is financed through 
state aid, which is given in amounts proportionate 
to that given for blind, deaf, and crippled children. 
This plan was designed for the care of the limited 
number of children who did not fit into a program 
of home care and regular classwork in school, and does 
not meet the needs of the much larger group whose 
problems must be dealt with out in the community. 
2) Assignment to classes for the handicapped. 
This plan is used in Los Angeles, where children 
whose seizures are frequent or severe are referred to 
schools for handicapped children.1 Special buses are 
provided by the Board of Education. The children 
are not segregated, except for reason of mental inca- 
pacity, and are given the advantages of full academic 
training, occupational training, and vocational guid- 
ance. A school nurse and physician are on duty in 
these schools. 
3) Home teaching. In New York and San 
Francisco children excluded from classes because of 
seizures are assigned to home teachers, after a 
clinical examination by physicians and a psy- 
1 Marion F. Mullin, "Educational Facilities for Children with Convulsive Seizures,” 
Master’s Field Study, Department of Social Service Administration, University of Chicago, 
1943, p. 24. chologist. The criteria for exclusion are repeated 
seizures in school, severe seizures, mental deficiency, 
degree of interference with classroom routine, danger 
of injury to others, difficulty in handling during an 
attack, and time attacks occur (morning and after- 
noon)1 Those with an LQ. below 75 are sometimes 
placed in ungraded classes. Buffalo, New York, con- 
ducts a special class for epileptic children. The great 
disadvantage to the child in home teaching is exclu- 
sion from normal group activity and isolation of the 
child. 
4) Custodial care. For children who are in 
need of full-time custodial care for intensive medical 
therapy, or because home conditions are unfavorable, 
special institutional care is needed. This is best ex- 
emplified by the State Demonstration and Practice 
School at Sonyea, Geneseo State Normal of Geneseo, 
New York, one of the few special institutions for per- 
sons with convulsive disorders in the United States. 
Children with I.Q.'s above 50 are admitted and placed 
in groups according to social maturity, the age range 
being from five to sixteen years. Academic work is 
minimized, most of the stress being laid on personal 
hygiene, handicrafts and non-reading activities.2 
Classes are held from kindergarten through eighth 
grade. 
Vocational guidance, training and placement 
The vocational outlook for this handicapped group 
is indeed restricted, since occupations must be chosen 
which have few physical or social hazards. There- 
fore, there is special need for occupational guidance 
and training, to help maintain morale, and so far as 
possible provide a means of earning a living com- 
1 Frederick L. Parry, “The Epileptic School Child,” N. Y. Jour. Med., 3 7 (September, 
1937), 1554. 
3 Helen R. Braem, “Education and the Epileptic,” Jour. Exceptional Children, VII 
(May, 1941), 316-20. patible with the interests, abilities, and inclinations 
of the individual. Especially must they be trained to 
perform tasks which give a sense of accomplishment 
and social usefulness. The sheltered workshop, where 
they may work without fear of discharge for physical 
condition, is greatly needed. One of the greatest draw- 
backs in employability of those subject to seizures is 
the employer-liability clause in workmen’s compen- 
sation laws, making the employer liable for injuries 
sustained during work. Occupations must be avoided 
which call for working at a height, using heavy 
machinery involving co-operation with others, and 
driving vehicles. Those occupations which are most 
favorable are farm work, clerical or library work, hor- 
ticulture, animal husbandry, music, writing, drafting, 
painting, and domestic service. Professionally trained 
persons such as doctors, teachers, lawyers, and minis- 
ters, may find useful and successful careers in branches 
of their fields which do not demand frequent public 
appearances before groups of people. 
Thus, the chief problem is the placement pro- 
gram, which would call for broad public educational 
activities, and a co-ordinated program of the employ- 
ment agencies and Division for Vocational Rehabili- 
tation. 
Public education As Schou has stated, “So long 
as people believe epilepsy incurable, just so long will 
people avoid treatment.’’1 For many reasons, an ex- 
tensive program of public interpretation and educa- 
tion should comprise a major phase of any state 
program. Tuberculosis, cancer, and the venereal dis- 
eases once occupied the place in the public mind now 
held by the convulsive disorders, and it was only 
through persistent, long-range educational programs 
1 Shon, “Institutional Care, etc.,” op. cit., p. 257. that the popular fear, superstition, and apathy sur- 
rounding them was broken down sufficiently to permit 
effective treatment programs to be established. The 
public must be informed that in some cases complete 
cessation of seizures can be achieved, in others they 
can be fully controlled with continued medication, 
and in still others, marked modification can be accom- 
plished. There will always be a number of cases in 
which little can be done, but in a majority, those suf- 
fering from the disorder can find relief and become 
happy and socially useful persons. 
Aside from development of public attitudes 
which will maintain rather than destroy morale, and 
promote rather than undermine mental health, there 
is a very real need to create conditions wherein persons 
subject to seizures will seek and find competent medi- 
cal services. Treatment of these disorders has been 
termed the “happy hunting ground of the quack."1 
Dangerous mail-order prescriptions and patent reme- 
dies for the epileptics form one of the most lucrative 
of all sources for medical quackery. This exploita- 
tion, made possible by the secrecy and taboo associated 
with the disorders, means that the patient not only 
does not secure proper medical attention, but pays 
exorbitant amounts for what he does receive.2 And 
society pays heavily for its prejudice and ignorance in 
this regard. 
Financing and costs In the main, the program 
should be state-financed, utilizing federal aid and 
private resources wherever possible. State aid should 
be made available for health services, maternal aid, and 
1.Muskens, op. cit. 
2 A report of the American Medical Association indicates that phcnobarbital, chief in- 
gredient of such patent remedies, costs the average patient $2.75 per year through pre- 
scription, but $50.00 a year by mail-order. (See Epilepsy Cures and Treatments, American 
Medical Association, 535 No. Dearborn St., Chicago.) aid to indigent patients. Provisions should be made 
for patients who are able to do so, to pay full cost 
for medical care. State aid is especially necessary in 
transportation costs to clinic school, and hospital 
centers. FACILITIES IN ILLINOIS 
Illinois, in common with other states in the 
Union, has met the problem of the convulsive dis- 
orders with gross neglect. 
Dixon State Hospital was established as a colony 
by an Act of the General Assembly approved on May 
27, 1913, providing for the treatment and instruc- 
tion of inmates.1 A year later, the Director of the 
Department of Public Welfare permitted admission of 
feeble-minded patients, in view of the fact that the 
state, was faced with a waiting list of over 1,000 at 
the Lincoln State School and Colony, and only 100 
admissions of persons with seizures had been made at 
Dixon.2 Within the limitations of overcrowded 
facilities, and an overburdened staff, modern medical 
and educational therapy is provided, but the tendency 
to commit only deteriorated persons, and the reluc- 
tance of parents to permit their children to be sent to 
an institution whose main function is care of the 
feeble-minded has prejudiced the original intention of 
the law establishing Dixon State Hospital. 
The Mary E. Pogue School at Wheaton and the 
Beverly Farm Home and School at Godfrey are the 
only private schools in Illinois which have reported to 
the Commission that they have diagnostic and treat- 
ment services for children with seizures. From 1913 to 
1940, the Chicago Board of Education maintained a 
special class for children subject to seizures, averaging 
eighteen in enrollment. For “reasons of expediency," 
1 Laws of Illinois, 1913, p. 133. 
3 Warren G. Murray, M.D., A Handbook of Information, Dixon State Hospital, 1935, 
p. 11. these classes were discontinued in the school year 
1941-42 and have not been re-instituted. The prob- 
lem of transportation was apparently one of the chief 
stumbling blocks in the program. 
In Chicago, diagnostic services are available 
chiefly through the following hospitals: Children’s 
Memorial Hospital, Montgomery Ward Clinics of 
Northwestern University, Research and Educational 
Hospitals of the University of Illinois, and the Uni- 
versity of Chicago Clinics. Among outpatient clinics 
treating children having seizures are Children's Memo- 
rial Hospital, Cook County Hospital, the Mandel 
Clinic of Michael Reese Hospital, Mercy Hospital, 
Mt. Sinai Hospital, Montgomery Ward Clinics, Pres- 
byterian Hospital, Provident Hospital, Research and 
Educational Hospitals, St. Luke’s Hospital, and the 
University of Chicago Clinics. 
Medical and home nursing services are available 
in Chicago and Cook County through the county 
physicians’ service, and the Cook County Public 
Health Unit. Two private agencies offering auxiliary 
services are the Visiting Nurse Association and the 
Infant Welfare Society. Several health clinics are 
maintained by the Chicago Board of Health. 
Downstate hospitals reporting diagnostic and 
treatment services for children with convulsive dis- 
orders are Norbury Sanatorium, Jacksonville; Silver 
Cross Hospital, Joliet; and Victory Memorial Hos- 
pital, Waukegan. UNMET NEEDS IN ILLINOIS 
Thousands of dollars can be saved by the com- 
munity annually through an adequate program for 
care of children with convulsive seizures. Illinois 
needs to make available and known to the public a co- 
ordinated plan of identification of cases, diagnosis and 
treatment. This should include nursing homes for 
treatable cases, and a system of aftercare for those 
living in their own or foster homes. Such aftercare 
would provide a means of supervising medical treat- 
ment, and offering guidance as to vocation and social 
adjustment. The need for this broader use of medi- 
cal social service has long been recognized by many 
authorities: 
The treatment of the epileptic, apart from the control 
of fits, is a matter of attending to the mental health both 
of the patient and his family. . . . The hospital 
doctor requires the help of the mental welfare worker as 
surely as the medical officer of health and the school medical 
officer require that of the health visitor and the school 
nurse.1 
If one were to consider the time and energy, and the 
personnel involved, in an effort to extend medical re- 
sponsibility to all the conceivable economic, sociological, 
and educational aspects of the problem of epilepsy, it 
should be easy to see why the physician taking care of an 
epileptic child must by necessity limit his endeavors [to 
the immediate medical problem.]2 
Special educational services are needed by large 
numbers of epileptic children who cannot benefit from 
or are not allowed to participate in the regular school 
program. The General Assembly has provided for 
1 Ralph H. Crowley, “The Social Care of the Epileptic,” The Lancet, 234 (January, 
1938), p. 61. 
2 Epileptic Children, p. 44. State aid in financing the costs of these services, but it 
remains for each community to recognize its local needs 
and initiate a plan for answering them. Closely co- 
ordinated with the school and medical program there 
is needed a program of vocational guidance, training, 
and placement, and a system of sheltered workshops. 
A campaign of public enlightenment is needed to 
educate both the general public and those subject to 
seizures as to the nature of the disorder, the fact that 
it can be remedied, and what resources are available. 
And, finally, the State needs to underwrite re- 
search in the field, so that a continuing program of 
research, closely linked with preventive effort, may be 
maintained to bring the full resources of the State 
to the aid of these thousands of long-neglected handi- 
capped children. RECOMMENDATIONS 
It is recommended, therefore: 
1) That an exhaustive study and statistical 
analysis of the problem of the epilepsies be made on 
a state-wide basis, to determine the extent of the prob- 
lem, what treatment resources are available, and how 
they are being used. 
2) That a system of case-finding and reporting 
be established. 
3) That special educational facilities be made 
available in the form of home teaching, hospital in- 
struction, and special classes, with transportation pro- 
vided where indicated. 
4) That the Chicago Board of Education be 
urged to establish special school facilities making use 
of existing resources. 
5) That there be required in the curricula of 
teacher-training institutions courses dealing with un- 
derstanding of behavior problems of children, and 
understanding and handling of the child who has 
seizures. 
6) That the public health service of the State 
establish facilities for care of extra-mural patients, 
based upon full use of available clinic and hospital 
resources, and development of further facilities where 
needed. 
7) That adequate psychiatric and medical so- 
cial work follow-up care be facilitated through inter- 
ested state departments. 
8) That fullest use be made of provisions of 
the maternal and child health aspect of the Social 
Security Act and the resources of the Aid to Depend- ent Children Program, the Division of Child Welfare, 
and other state-wide social services, in promoting 
social welfare of this group of handicapped. 
9) That the work of the Division of Voca- 
tional Rehabilitation be expanded to serve the special 
needs of this group for vocational guidance, training, 
and placement, with special attention given to the 
establishment of a system of sheltered workshops. 
10) That the Workmen's Compensation Law 
be amended, to shift injury liability from the employer 
to the State Treasurer’s Fund, in cases involving per- 
sons with convulsive seizures. 
11) That preventive efforts be advanced 
through public education by the Department of Public 
Welfare and Department of Public Health with re- 
spect to means for reduction of incidence of infectious 
diseases which lead to damage of the central nervous 
system; and promotion of better obstetrical practices, 
to reduce the number of birth injuries. 
12) That a program of public education be 
promoted with the aid of newspapers, magazines and 
other distributed literature, the radio, and public 
meetings, to insure early reporting and treatment of 
cases; to advise against resorting to use of mail-order 
remedies; and to enlighten the general public with 
respect to the nature of the problem and the urgent 
need for dealing with it. 
13) That a continuing program of research be 
carried on with the sponsorship and aid of the State. BIBLIOGRAPHY 
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Baltimore: Williams & Wilkins, 1940. 2 vol. ACKNOWLEDGMENT 
All publications of the Commission for Handi- 
capped Children are a result of the combined 
efforts of all members of its staff. To them recog- 
nition is hereby made. 
Jane Bull 
Informational Representative 
Eveline E. Blumenthal 
Social Research Analyst 
Virginia D. Bonnici 
Librarian 
Helen A. Eggers 
Secretary