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BECKETT'S POLITICAL IMAGINATION

Beckett's Political Imagination charts unexplored territory: it

investigates how Beckett's bilingual texts reimagine political history,
and documents the conflicts and controversies through which
Beckett's political consciousness and affirmations were mediated.
The book offers a startling account of Beckett's work, tracing the
many political causes that framed his writing, commitments,
collaborations and friendships, from the Scottsboro Boys to the Black
Panthers, from Irish communism to Spanish republicanism to
Algerian nationalism, and from campaigns against Irish and British
censorship to anti-apartheid and international human rights
movements. Emilie Morin reveals a very different writer, whose
career and work were shaped by a unique exposure to international
politics, an unconventional perspective on political action and
secretive political engagements. The book will benefit students,
researchers and readers who want to think about literary history in
different ways and are interested in Beckett's enduring appeal and
influence.

EMILIE MORIN is Senior Lecturer in the Department of English and

Related Literature at the University of York. She works on modern
literature, theatre history and forms of political writing. She has
published widely on the work of Samuel Beckett, including a
monograph entitled Samuel Beckett and the Problem of Irishness
(2009), and has co-edited Theatre and Ghosts: Materiality,
Performance and Modernity (2014) and Theatre and Human Rights
after 1945: Things Unspeakable (2015).
BECKETT'S POLITICAL
IMAGINATION
Emilie Morin
University of York
 University Printing House, Cambridge CB2 8BS, United Kingdom

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Information on this title: www.cambridge.org/9781108417990

DOI: 10.1017/9781108284011

© Emilie Morin 2017

This publication is in copyright. Subject to statutory exception and to the provisions of

relevant collective licensing agreements, no reproduction of any part may take place
without the written permission of Cambridge University Press.

First published 2017

Printed in the United States of America by Sheridan Books, Inc.

A catalogue record for this publication is available from the British Library.

Library of Congress Cataloging-in-Publication data

Names: Morin, Emilie, 1978– author.

Title: Beckett's political imagination / Emilie Morin.

 Description: New York : Cambridge University Press, 2017. | Includes

bibliographical references and index.

Identifiers: LCCN 2017020175 | ISBN 9781108417990 (hardback)

Subjects: LCSH: Beckett, Samuel, 1906–1989 -- Knowledge -- Politics. | Beckett,

Samuel, 1906--1989 -- Criticism and interpretation. | BISAC: LITERARY

CRITICISM / European / English, Irish, Scottish, Welsh.

Classification: LCC PR6003.E282 Z78163 2017 | DDC 823/.912--dc23 LC record

available at https://lccn.loc.gov/2017020175

ISBN 978-1-108-41799-0 Hardback

Cambridge University Press has no responsibility for the persistence or accuracy of

URLs for external or third-party internet websites referred to in this publication and
does not guarantee that any content on such websites is, or will remain, accurate or
appropriate.
For Nick
 Contents
Acknowledgements
Notes and Abbreviations

Introduction

1False Starts: The ‘Material of Experience’ and the Writing

of History

2Another War Entirely: Internationalist Politics and the

Labour of Translation

3Aftermaths: The ‘Siege in the Room’ and the Politics of

Testimony

4Turning Points: Torture, Dissent and the Algerian War of

Independence

Conclusion

Select Bibliography
Index
 Acknowledgements
As I write these lines, a decade has elapsed since I began
researching a book on Beckett and politics. The research support
offered by the Department of English and Related Literature at the
University of York enabled me to write the actual monograph, and
the book-in-progress was nurtured by years of conversations with
friends, students and colleagues. Thanks are due to Derek Attridge
and Hugh Haughton, for their support and generosity; to Michelle
Kelly, for her input and responses to chapter drafts; to Lauren
Arrington, Aisling Carlin, Victoria Coulson, David Dwan, Jason
Edwards, Mary Fairclough, Helen Fulton, Kevin Killeen, Catherine
Laws, Mary Luckhurst, Emma Major, Michael McAteer, Jon Mee, Linne
Mooney, Bryan Radley, Lawrence Rainey, Reena Sastri, Freya
Sierhuis, Helen Smith, Elizabeth Tyler, Claire Westall and Michael
White, for research conversations about major and minor book
matters; to Boriana Alexandrova, for enriching discussions and for
the index; and to Megan Girdwood, Timothy Lawrence, Julia Mason,
Jay James May, Alexander Price and Nick Wolterman, for stimulating
dialogues. My appreciative thanks to Marthe Gautier and Tommy
Murtagh, for kindly agreeing to speak to me about Samuel and
Suzanne Beckett; to David Barnett, Emmanuel Blanchard, Raphaëlle
Branche, Salem Chaker, Monique Courty-Garnier, Marie Cosnay,
Masin Ferkal, Jim House, Daniel Lee and Renata Morresi, for their
readiness to reply to research queries and their generosity; to Mark
Nixon, for judicious advice and archival expertise; to Deirdre Bair,
Maurice Harmon, James Knowlson and John Pilling, for helpful
responses to Beckett-related questions; to Jean-Michel Rabaté and
Seán Kennedy, for their close reading of the manuscript as external
peer-reviewers; and to Elizabeth Barry, Peter Boxall, Alan Warren
Friedman, Julian Garforth, Jonathan Heron, Patrick Lonergan, Ulrika
Maude, Rónán McDonald, James McNaughton and the late Rosemary
Pountney, for thought-provoking discussions about Beckett. Many
thanks also to Amélie and Olivier Cahn, Dominique and Bernadette
Coco, Paul Cooney, Lisa Foran and Nilantha McPartland, Orlaith
Fitzpatrick, Willow Coyle and Helen McClements, for their hospitality.
It has been a pleasure to work with Ray Ryan at Cambridge
University Press, and I thank him for his support and extraordinary
dedication. I began assembling materials for this book after my
doctorate at Queen's University Belfast; the research ethos of friends
and mentors in the School of English at Queen's and at University
College Dublin has remained a source of inspiration. Ultimately, none
of this would have been possible without the support of my parents
and siblings, Anne, Jean, Jean-Baptiste and Loïse, and the support
of the Melia family. I also owe more than I can express to Nicholas
Melia, for years of intellectual nourishment, responses to chapter
drafts and so much more. This book is dedicated to him, with all my
gratitude for making so much else possible.
The research for this book was conducted in many archives and
research libraries including the BBC Written Archives, Caversham;
the Beckett International Foundation, University of Reading; the
British Library; the Harry Ransom Humanities Research Center,
University of Texas at Austin; Oxford's Taylor Institution Library;
Trinity College Dublin; the National Library of Ireland; the
Bibliothèque Polonaise, Paris; the Bibliothèque Sainte-Geneviève,
Paris; and the Institut Mémoires de l'Edition Contemporaine, Caen,
where I was able to consult the Beckett collection by kind permission
of Edward Beckett and Irène Lindon. Thanks are also due to the
Andrew W. Mellon Foundation, for the fellowship that enabled me to
work on Ransom Center collections in 2012; to Elizabeth L. Garver at
the Ransom Center, for supplying the cover image; to Lisa Eveson,
Olivia Else, Margaret Dillon, Lisa Hopwood, Elaine Hickes and Keith
Webster at the University of York library; Justine Sundaram at the
Burns Library, Boston College; Jane Maxwell at Trinity College
Dublin; Monica Thapar and Louise North at the BBC Written
Archives; and York's F. R. Leavis Fund, for covering research and
indexing costs.
An early version of the subsection entitled ‘Inquests and
Investigations’ in Chapter 3 was published as ‘Beckett's Inquests:
Malone Dies and the Mysteries of the State’, in Revisiting Molloy,
Malone meurt/Malone Dies and L'Innommable/The Unnamable, ed.
David Tucker, Mark Nixon and Dirk Van Hulle, spec. issue, Samuel
Beckett Today/Aujourd'hui 26 (2014): 137–50.
I thank the Dedalus Press, acting for the Devlin Estate, for kind
permission to cite from Denis Devlin's unpublished correspondence,
held at the Ransom Center; Indiana University Press, for allowing me
to cite from Octavio Paz's Anthology of Mexican Poetry, translated by
Samuel Beckett (Indiana University Press, 1958); Fondo de Cultura
Económica, for allowing me to cite from the poems of Alfonso Reyes;
Association Guy Lévis Mano, for permission to cite from Guy Lévis
Mano's translations in Octavio Paz's Anthologie de la poésie
mexicaine (© Association GLM).
 Notes and Abbreviations
Unless otherwise indicated in the footnotes, all translations from
non-English sources are by the author.
Samuel Beckett is designated as SB in the footnotes.

BR/RB:
Beckett Remembering/Remembering Beckett, ed. James and Elizabeth Knowlson
(New York: Arcade Publishing, 2006)

CDW:
Samuel Beckett, The Complete Dramatic Works [1986] (London: Faber, 2006)

Chronology:
John Pilling, A Samuel Beckett Chronology (Basingstoke: Palgrave Macmillan, 2006)

DF:
James Knowlson, Damned to Fame: The Life of Samuel Beckett (London: Bloomsbury,
1996)

DFMW:
Samuel Beckett, Dream of Fair to Middling Women, ed. Eoin O'Brien and Edith
Fournier (London: Calder, 1992)

D:
Samuel Beckett, Disjecta: Miscellaneous Writings and a Dramatic Fragment, ed. Ruby
Cohn (London: Calder, 1983)

IT:
Irish Times

JoBS:
Journal of Beckett Studies

JORF:
Journal officiel de la République française

LM:
Anthony Cronin, Samuel Beckett: The Last Modernist [1996] (London: Flamingo,
1997)

LSB1:
The Letters of Samuel Beckett, vol. 1: 1929–1940, ed. Martha Dow Fehsenfeld and
Lois More Overbeck (Cambridge: Cambridge University Press, 2009)

LSB2:
The Letters of Samuel Beckett, vol. 2: 1941–1956, ed. George Craig, Martha Dow
Fehsenfeld, Dan Gunn and Lois More Overbeck (Cambridge: Cambridge University
Press, 2011)

LSB3:
The Letters of Samuel Beckett, vol. 3: 1957–1965, ed. George Craig, Martha Dow
Fehsenfeld, Dan Gunn and Lois More Overbeck (Cambridge: Cambridge University
Press, 2014)

LSB4:
The Letters of Samuel Beckett, vol. 4: 1966–1989, ed. George Craig, Martha Dow
Fehsenfeld, Dan Gunn and Lois More Overbeck (Cambridge: Cambridge University
Press, 2016)

MPTK:
Samuel Beckett, More Pricks than Kicks [1934] (London: Calder, 1993)

NABS:
No Author Better Served: The Correspondence of Samuel Beckett and Alan Schneider,
ed. Maurice Harmon (Cambridge, MA: Harvard University Press, 1998)

NYT:
New York Times
SB:
Deirdre Bair, Samuel Beckett: A Biography (London: Jonathan Cape, 1978)

SBTA:
Samuel Beckett Today/Aujourd'hui

Trilogy:
Samuel Beckett, Molloy, Malone Dies, The Unnamable [1959] (London: Calder, 1994)
 Introduction
There is, seemingly, little to say about Beckett's politics. Many
interviews and memoirs portray a writer peculiarly unqualified for
political activity, ill-at-ease with mundane realities and more
comfortable with philosophical abstraction. Some have celebrated his
apparent detachment from the political world: notably, on the
occasion of Beckett's seventieth birthday, Emil Cioran paid tribute to
a figure living ‘parallel to time’, gifted with the ability of making
others ‘understand history as a dimension man could have dispensed
with’.1
Such established consensus, however, flies in the face of
abundant evidence to the contrary. Beckett's texts, with their
numerous portrayals of violence, torture, dispossession, internment
and subjugation, harbour a real political immediacy, while his
notebooks, manuscripts and correspondence reveal a fine and astute
observer of political symbols, attuned to the long history of political
myths in the Irish Free State, Nazi Germany and France in the
aftermath of the Second World War and during the Algerian War of
Independence. The literary cultures in which he worked were
intensely politicised, and there is little in his translations, his
collaborations, the publishing and dissemination of his texts that
does not carry a political charge. For the editors who represented his
professional position and interests – Jérôme Lindon, Barney Rosset
and John Calder – publishing came with distinctive responsibilities to
defend civil liberties and freedom of expression. Their catalogues
bring Beckett's texts into proximity with important turning points in
political thought: the Editions de Minuit situate Beckett in the same
cultural and material spheres as Leon Trotsky, Herbert Marcuse,
Nelson Mandela, Henri Lefebvre or Gilles Deleuze, while Grove Press
boasts works by Roger Casement, Franz Fanon, Malcolm X and Che
Guevara alongside Beckett's slim volumes.
Naturally, there are many ways of apprehending the political
currency of Beckett's texts within the national and global contexts in
which they were written, read and performed. In the past decade,
numerous studies have explored the intricacy and multiplicity of
Beckett's historical experiences, emphasising the enduring capacity
of the writing to speak to circumstances marked by war, suffering
and oppression. Yet the obstacles to understanding the work's
political tenor have often seemed insurmountable: to discuss
Beckett's relation to politics is to confront, all too often, a series of
impediments to political reflection and political action. Some
assumptions – that Beckett did not give interviews, had little political
sentiment, was not interested in current affairs and did not sign
petitions – have left a tenacious legacy, and have been compounded
by a long-standing tendency to interpret the texts as expressions of
a tortured psyche.
The purpose of this book is neither to assess the grounds upon
which Beckett may be considered a political writer, nor to reflect on
the politics of non-naturalistic forms. Beckett, who worked in
different languages, cultural industries and artistic media at the
same time, tends to test many of the pieties surrounding available
categories of political writing – categories which are historically and
culturally specific to such a degree that they often obfuscate the
tensions that have commonly arisen between political activity and
creative work, even for writers commonly considered as politically
engaged and revolutionary. Rather, my aim is to reinscribe Beckett
and his work into their political milieux. This task involves
documenting the political coordinates of Beckett's bilingual oeuvre,
and its tangential reimagining of the political histories of Ireland,
France and Europe through satire, displacement, elision, substitution
and imaginative appropriation. To reinscribe Beckett's career into its
political milieu is also to negotiate the relation between the domain
of political activity and a sphere of citizenship which, in Beckett's
case, remains a mutating concept involving the inherited, the elected
and the imagined. The conjunctions and disjunctions between
Beckett's literary and political work are equally important, and this
book pays heed to the tensions that frequently developed between
Beckett's work as essayist, translator and public figure and the
demands of writing, and foregrounds his shifting positions as
observer and participant in diverse forms of political activism
developing in France, Great Britain and Europe after the interwar
years. Beckett was far more than a sardonic observer of political
folly; he endorsed numerous international petitions in which the
defence of freedom of speech for artists, publishers and intellectuals
acted as a response to specific political urgencies, more than a
simple matter of liberal principle. His contributions to petitions are
scrutinised and contextualised here for the first time. Three different
periods are brought together: the 1930s, during which Beckett's
identities as writer, translator and critic were formed; the great
artistic turning point known as the ‘siege in the room’ between 1946
and 1948,2 which came with different political demands and
urgencies; and the period between 1958 and 1962, marked by other
kinds of political activism and a new reflection on literary and
dramatic forms.
Chapter 1, ‘False Starts: The “Material of Experience” and the
Writing of History’, considers Beckett's frustrated efforts as a
historical writer and political essayist, tracing his shifting perspective
on the fortunes of the Irish Left and his responses to the debates
that shaped the accession of Fianna Fáil to power, the rise of the
Blueshirts and the dynamics of anti-communist sentiment in the Irish
Free State during the 1930s. During periods of time spent in Dublin,
London, Paris and Germany, Beckett wrote politically inflected
parodies inspired from eighteenth-century traditions of life writing
and pamphleteering, making various attempts to integrate historical
subject matter into his work, albeit with mixed results: some of
these texts were abandoned or remained unpublished for decades,
in keeping with his wishes. This chapter investigates the distinctive
ways in which this body of work ventriloquises competing idioms in
Irish political culture, interrogating the narratives of political
exclusion and disaffection that are commonly deployed in discussions
of Beckett's early writing. The cultures through which his political
education was mediated at Trinity College Dublin and the Ecole
Normale Supérieure in Paris, his friendships and literary
partnerships, and his plans to travel to Moscow and experiences in
Nazi Germany are central to my discussion.
Chapter 2, ‘Another War Entirely: Internationalist Politics and
the Labour of Translation’, explores the ways in which Beckett's
political interests impacted on his translation practices, showing that
his numerous translations of texts by other writers offer a fruitful
terrain for charting his responses to broader mutations within anti-
colonial politics and the internationalist Left. The peculiarities of
Beckett's practice as ‘jobbing’ translator are known through the work
of Sinéad Mooney, who has demonstrated that these activities are
inseparable from the thematic preoccupations and the form of his
self-translated texts.3 My chapter considers how the work of
translation, for Beckett, was inscribed in a wider reflection on the
history of empire, colonialism, social injustice and segregation,
conducted not only by others but also by himself as translator. Of
particular importance are his contributions to Negro: Anthology
Made by Nancy Cunard, 1931–1933 (1934), an endeavour that owed
much to anti-segregationist campaigns and international
organisations such as the League Against Imperialism and Colonial
Oppression, and Octavio Paz's Anthology of Mexican Poetry (1958), a
work commissioned by UNESCO and indexed to rising Cold War
tensions. My discussion addresses the circumstances in which these
anthologies were compiled and published, the dialogues that shaped
Beckett's engagement with their internationalist remit, and his
shifting relation to the politicised literary cultures of Surrealism.
The Second World War did not instigate Beckett's political
consciousness: this was forged through other means, notably
translation. However, the war's aftermath granted him a new political
identity, shaped by his connections to the new literature of the
French Resistance. The subsequent chapters turn to Beckett's
internationalist politics after 1945, charting the evolution of his
political thinking through his struggles with historical writing and
testimony. Chapter 3, ‘Aftermaths: The “Siege in the Room” and the
Politics of Testimony’, considers how Beckett's novellas and novel
trilogy render the thorny and unresolved legacies of French
collaborationism, while charting their relation to literary debates
about the remit of historical testimony dominated by the voices of
non-Jewish survivors. ‘Suite’, Mercier et Camier, Eleutheria, Molloy
and Malone meurt or Malone Dies are of particular significance to
this chapter, as texts that reflect on the principles of testimony as
well as the conventions of detective fiction.
Beckett's conflicted relation to the reimagining of Nazi
occupation in post-war France bears upon the subjects that he
addressed in the 1950s and 1960s, and upon the dramatic and prose
texts he wrote during the Algerian war (1954–1962). My final
chapter, ‘Turning Points: Torture, Dissent and the Algerian War of
Independence’, focuses on the Algerian war and its impact on
political activity, in Paris in particular, examining the connections
between Beckett's representations of torture and guerrilla war, and
wider debates about decolonisation, historical repetition and political
legitimacy, which found expressions across the catalogue of the
Editions de Minuit and other politically informed publications. The
cultures of dissent that crystallised in France around Lindon and
others ignited a profound change in Beckett's view of his own remit
as a writer, and his work bears many traces of his attempts to
imagine new historical transparencies, appropriate to shifting
political circumstances. Looking at the fraught political contexts in
which Beckett worked further illuminates his internationalist politics,
revealing how, under genuine duress, the challenges to political
activism become greater than commonly acknowledged. Offering a
new context for understanding Catastrophe, commonly perceived as
Beckett's only direct political gesture, the conclusion documents his
responses to political debates about censorship, freedom of
expression and human rights tied to the cultural politics of the Cold
War, discussing the many petitions that he endorsed during the
1970s and 1980s and the work's continued political significance.
 Politics and the Making of Beckettian Myths
Since the 1950s, much attention has been paid to the structural
ambiguity of Beckett's writing – more precisely, to the capacity of the
Beckettian sentence to interrogate the conditions of its own
possibility, and its intimacy with omission, elision and unspeakability.
Maurice Blanchot was the first to scrutinise the tension between the
obligation to speak and the impossibility of continuing to speak
central to so many of Beckett's texts: his celebrated essay on
L'Innommable read the novel according to its own narrative terms,
since familiar literary and theoretical models failed to account for its
apparent placelessness and remoteness.4 Following the novel's
opening salvos, ‘Where now? Who now?’, Blanchot presented as
Beckett's principal design the creation of a narrative voice divorced
from recognisable political and historical parameters. A decade later,
the same line acquired a different weight in notes that Theodor
Adorno compiled on the novel's German counterpart: for Adorno,
Beckett was engaged in a critique of solipsistic writing indebted to
dialectical materialism, which also harboured a reflection on utopia
complicit with the work of Ernst Bloch.5 From Adorno's perspective,
the historicity of Beckett's work revolved around its resistance to
clear-cut referents, and its apophatic and euphemistic mode
conveyed a proximity to horror, war and genocide. Such reflections
are part of a wider endeavour to rethink the critical value of
pessimism: for Adorno as for other theorists of the Frankfurt School,
pessimism was the only philosophical route available in order to
interrogate contemporary irrationality.6 As political critique, however,
Beckett's work had clear limitations: for Adorno, the very idea of
Beckett ‘as a key political witness’ was ‘ridiculous’.7 Following his
study of Endgame, however, Adorno reconfigured the terms of the
equation, reaching striking conclusions about the demise of
consensual political forms, and presenting Beckett and Kafka as the
only writers able to gesture towards a new political art that
‘explode[s]’ the strictures of socialist realism, Sartrean commitment
and Brechtian technique.8
 Many subsequent commentaries have made Beckett an
attractive philosophical subject by virtue of his capacity to portray
destruction and suffering. Seldom, however, have the philosophical
and the political been perceived as Beckettian concerns of equal
measure. Notable exceptions include Alain Badiou's reflection on
Beckett's ‘political tenacity’ and the recent work of Slavoj Žižek, who
returns to Beckett's celebrated variations on failing and going on
when discussing the legacy of communism, utopian political thought
and other ‘lost causes’.9 For Žižek, Beckettian aphorisms on the
inevitability of failure can offer an imaginative way back to utopian
thought, and resonate with the challenges that Che Guevara and
Mao Zedong faced when articulating their own political visions and
doubts.
As these disparate reflections reveal, the kind of political event
to which Beckett's work responds tends to evade neat associations,
largely because his career was shaped by circumstances in which the
domain of the political was frequently boundless, and the
dichotomies between political and aesthetic reflection frequently
obscure. Jacques Rancière's work sheds light on this problem: in an
essay taking issue with Hannah Arendt's and Giorgio Agamben's
definitions of the political sphere of human rights, Rancière
excavates a different realm of political activity, and re-examines the
traditional oppositions between the private individual and the public
citizen. The political subject, for Rancière, is the subject who can
‘put to test the power of political names, their extension and
comprehension’, and who has the ‘capacity for staging […] scenes of
dissensus’ (or ‘putting two worlds in one and the same world’).10
Politics is apprehended accordingly, as the border between the
sphere of citizenship – or political life – and the sphere of private life
on the one hand, and, on the other, as the ‘activity that brings [that
border] back into question’. Similar tensions underlie the argument
developed in this book, not least because the problem of where the
personal ends and the political begins shaped so many aspects of
Beckett's life and artistic endeavour.
 Over the course of the historical period addressed here, the field
of political thought has been ceaselessly redefined, in debates
frequently underscored by anxieties concerning the workings of
democracy, totalitarianism, the birth and death of political utopias,
and the possibility of an end point to the political. Claude Lefort,
notably, has defined the political as the dynamic that circumscribes
and institutes politics in the social sphere, and is ‘revealed, not in
what we call political activity, but in the double movement whereby
the mode of institution of society appears and is obscured’. More
specifically, the political appears ‘in the sense that the process
whereby society is ordered and unified across its divisions becomes
visible. It is obscured in the sense that the locus of politics (the locus
in which parties compete and in which a general agency of power
takes shape and is reproduced) becomes defined as particular, while
the principle which generates the overall configuration is
concealed’.11 Pierre Bourdieu has offered similar definitions of the
duality of the political field, stressing its capacity to function ‘both as
a field of forces and as a field of struggles aimed at transforming the
relation of forces which confers to this field its structure at any given
moment’.12 For Bourdieu, politics is an elusive force, both known and
unknown, stamped by a ‘blinding familiarity’ that precludes a
genuine understanding of the political world.13
Conceptualisations of politics as a totality that functions
dialectically and involves shifting patterns of legibility are particularly
pertinent to the diverse European moments to which Beckett's work
of displacement and translation is sutured. Indeed, the literary
worlds in which his political sensibility was articulated remained
shaped by intractable tensions around the visibility of political
activity and the legibility of political transformations. This multiplicity
and simultaneity pose serious challenges to scholarly enquiry, and
have pushed discussions of politics to the margins of Beckett studies.
One moment is frequently invoked: Beckett's decision to join the
French Resistance in September 1941, widely considered as the
logical outcome of a political experience garnered in 1936 and 1937,
during a formative journey through Nazi Germany. Ultimately,
however, little is known about the political mechanisms that shaped
Beckett's familiarity with the idioms of fascism, communism,
Stalinism or the conservative Right. Since the turn of the millenium,
publications clearly signposted as explorations of the political Beckett
have focused on other terrains, dominated by the prevalent sense
that the work's political dimensions revolve primarily around its
Irishness. Beckett's fractured relation to his privileged social class,
his perspective on Irish Free State politics, and the tensions
contained within the work between neutrality and engagement have
been prioritised in these debates.14 Variously, Peter Boxall and Leslie
Hill have discussed the fundamental problems inherent in outlining
Beckett's political coordinates, pointing to the considerable
difficulties posed by the bilinguality of the work, which forbids the
construction of a stable political and historical referent to which
critical readings can then be indexed.15 Beckett's fiction, Boxall
remarks, ‘has stood at a very peculiar, oblique angle to the cultures
that have produced it’, and inhabits ‘a different history altogether, a
history that cannot easily be slotted between 1929 and 1989’.16
In the realm of theatre, Beckett's work has also acquired its own
peculiar temporality, not least because his plays have remained
stubbornly embedded in politicised areas of performance practice.
His legacy is strewn with paradoxes: Suzan-Lori Parks, for example,
has described Beckett as someone who had an innate understanding
of social and political marginalisation, on the grounds that he ‘just
seems so black to [her]’.17 It is largely through the performance
history of Waiting for Godot and Endgame in situations of political
hardship and oppression that Beckett's name has migrated into
debates about the nature of political writing. Notably, in partitioned
Germany and beyond the Iron Curtain, during the 1950s and
thereafter, his early plays were commonly perceived as having a
stark, yet somewhat imprecise, political dimension.18 These
developments grate with available models of political theatre, which
tend to focus on the practices pioneered by Brecht, and foreground
the unrelenting pessimism of Beckett's drama and its emphasis on
absence and silence, commonly perceived as obstacles to political
traction. It is fair to say that Beckett has remained a moving target
in theorisations of political theatre – particularly in British contexts,
where debates about the idea of political writing pose interesting
questions about the continued pre-eminence of social realism. For
writers such as Dennis Potter, John Arden and Edward Bond, the
idea of Beckett as a political playwright was anathema, and the
ruthless critiques of his work that they issued at various points from
the 1960s to the 1980s were also critiques of its dissociation from
naturalism. Elsewhere, numerous actors and directors have
celebrated Beckett's distinctive take on hope and despair, and the
capacity of his plays to give rise to transformative political allegories
– in this respect, the work of the San Quentin Drama Workshop,
whose work Beckett supported over the years, has proved
immensely important. Some performances of Waiting for Godot – in
particular, the bilingual Hebrew-Arabic production directed by Ilan
Ronen in Haifa in 1984 and Susan Sontag's 1993 production in
Sarajevo – have been celebrated for their capacity to generate
political metaphors appropriate to times of great international
tension.19 Such politicised interpretations emerge from a longer
history of acting and directing: for Roger Blin, Beckett's first director,
En attendant Godot always had a political remit, and all other
aspects of the work stemmed from that political origin.20 Ironically,
one of the first to publicly acknowledge the political power of
Beckett's early plays was Jean-Paul Sartre: at a conference in Bonn
in 1966, he celebrated Genet, Ionesco, Adamov and Beckett as the
vanguard of a new political theatre that questioned the
insufficiencies of theatre itself, rather than life's absurdity.21 This idea
was firmly at odds with Sartre's previous pronouncements on the
theatre of the absurd. The position of Ernst Fischer, the Communist
veteran, shifted further still; after denouncing the ‘macabre idiocy’ of
Endgame, he revised his opinion, forcefully arguing that the play
deals with exactly the same problem as Aleksandr Solzhenitsyn's
One Day in the Life of Ivan Denisovich: unfreedom.22 Ernst Bloch
concurred.23
 The sense that Beckett, as a playwright, was also a political
figure has sometimes given rise to unlikely exchanges; for example,
when Harold Hayes, editor of Esquire, invited him to cover the 1968
American Democratic Convention in Chicago alongside Eugène
Ionesco and Jean Genet.24 Beckett and Ionesco declined; Genet,
Terry Southern, William Burroughs and the war journalist John Sack
penned striking reports of this legendary convention, marked by
escalating protests against the Vietnam War. Such side-stepping was
not unusual, yet many other anecdotes attest to Beckett's
confrontations with the day-to-day demands of politics. Ultimately,
however, very little is known about the histories and ideologies
through which Beckett's connections with political theatre were
formed. Rather, in theatre studies, much emphasis has been placed
on Catastrophe and What Where, commonly described as political
but in a non-specific sense. In that strand of the discussion, which is
indexed to the end of the Cold War and the dissolution of the Soviet
bloc, ‘political’ tends to mean conventionally liberal, and Beckett's
political identity is defined in accordance with a seemingly uprooted
politics of free speech and empathy, carrying the promise of a new
Western-dominated polity in which the artist's voice can act as a
political force in its own right. The common emphasis on Beckett's
capacity to ventriloquise contemporary liberal values has had some
unfortunate side-effects, and has obscured the rich traditions of
political thought that feed his work, and the longer historical span to
which it responds. In fact, Beckett's relation to post-1970s liberal
values only constitutes a small part of a much more difficult
equation.
When reflecting on the challenges raised by Beckett's writing,
scholars have tended to be somewhat more partial to the questions
outlined by Blanchot than to those discussed by Adorno, and have
generally avoided the granular and meandering narratives of the
political. Indeed, Pascale Casanova has argued that, especially in
France, Blanchot's configuration of the Beckettian voice has
remained ‘the sole authorized commentary’, helping to ‘fabricate a
tailor-made Beckett, hero of “pure” criticism’, who lacked ‘a history, a
past, an inheritance or a project’.25 This process of severance can be
traced through portrayals of Beckett as figurehead of the new
‘alittérature’ and the literature of ‘unrevolt’ in the 1950s.26 Blanchot's
reading of a Beckettian prose driven by a voice that comes from
nowhere, as a challenge to hermeneutics and narration, continues to
shape Beckett's critical reception and to inform arguments
celebrating his anti-historical spirit and philosophical achievements.
This consensus around a Heideggerian Beckett is, nevertheless, in
need of some reconsideration in the wake of other reappraisals of
Blanchot's politics and controversies around Heidegger's legacy.27 In
the last two decades, numerous studies have put influential
interpretations of modern intellectual history to the test, demanding
a better integration of political questions into examinations of
theoretical and literary writing. These developments have
implications for Beckett scholarship, where Beckett's relation to
history has been carefully scrutinised since the publication of James
Knowlson's biography. The Beckett that has emerged from this
reappraisal is a courageous yet mysterious figure, unafraid of the
spectral silences and absences inherent in historical narratives. The
version of Beckett presented in this book is indebted to the tradition
of historicisation furthered by Andrew Gibson and Lois Gordon, who
have documented the cultural circumstances in which Beckett turned
to writing and rose to fame, and to the work of Elizabeth Barry,
Patrick Bixby, Matthew Feldman, Seán Kennedy, Rónán McDonald,
James McNaughton, Sinéad Mooney, Mark Nixon and John Pilling, to
name some of the many scholars who have explored the diverse
European histories shaping Beckett's career and his texts.
Nonetheless, there are major differences between this large field
driven by diverse historicisation methods and the far smaller body of
scholarship strictly focused on the political Beckett. Reflecting on the
work's political currency raises important questions about the
relation between the author's creative imagination and the published
work, the remit of personal persuasions and their modes of
expression, the circumstances of the work's reception in different
languages and literary cultures – and, last but not least, the politics
of accepted historical narratives utilised as part of the process of
contextualisation. These are problems of great magnitude, to which
Peter Boxall has been particularly sensitive.28
Ultimately, defining a Beckettian politics has remained a perilous
exercise, not least because different diagnoses of his political
sympathies have been advanced over time. In 1978, Deirdre Bair
portrayed Beckett as a hermit who was ‘consistent in his apolitical
behaviour’, for whom politics was ‘anathema’, and who ‘walked away
from any conversation that veered into politics’.29 In 1996, Knowlson
presented a very different author, whose perspective was ‘basically
left-wing and anti-establishment’; his biography described Beckett's
opposition to Nazism, apartheid and all forms of censorship, and his
immense generosity towards friends in need.30 In a later essay,
Knowlson identified political commitments that were often driven by
chance and personal acquaintance, concluding that Beckett's political
activism ‘operated mainly at a private and individual level’.31
Likewise, W. J. McCormack has asserted that Beckett's politics
consisted of occasional activation and de-activation of political
conscience as circumstances shifted; Alan Warren Friedman and
Jackie Blackman have argued that Beckett was impervious to
partisan politics, but remained driven by an unfailing loyalty to his
friends and a deep concern about suffering.32 Such models of
political activity ascribe to Beckett an erratic tendency to act as
mouthpiece for beliefs and struggles that are not his own, an
incapacity to engage with political problems as part of a more
systematic and principled investigation, and a residual naivety.
This book charts different ideological and political affiliations,
through Beckett's eagerness to reclaim the dregs of historical
narrative as his material, his fascination for a broad spectrum of
radical politics, and a work of translation conducted in the shadows
of international campaigns. The Easter Rising, Irish independence
and partition, the Nazi occupation of France and Vichy's National
Revolution, the threats of a coup d’état during the Algerian war, the
partition of Germany and Berlin, and the Iron Curtain were not
political abstractions for Beckett, but material realities that shaped
his youth and later career in the worlds of translation, theatre and
television. Few writers of his generation witnessed as many
revolutions and counter-revolutions, and as many wars concealed
under the pretence of peace. Exposure to danger and upheaval
clearly stimulated his imagination: he began to think about a play on
the life of Samuel Johnson in December 1936, while in Nazi
Germany, and worked on Human Wishes during the ‘phoney war’
that preceded the partition and Nazi occupation of France; he wrote
Watt during wartime periods marked by great uncertainty, and
began translating Murphy with Alfred Péron in the midst of
Resistance activities involving the synthesis, duplication and
translation of military intelligence. His responses are never devoid of
complexity, particularly when he affirmed a distance from
conventional models of politicisation. When Richard Stern asked him,
in 1977, whether he ‘was […] ever political’, Beckett reportedly
answered, ‘No, but I joined the Resistance’.33 The connotations of
this ‘but’ as well as other slippery questions surrounding this pivotal
period are explored in this book; my aim is to work beyond the
accepted narrative concerning Beckett's political maturation, by
tracing the subtle continuities between his writing and the political
worlds in which his career unfolded.
To read Beckett's texts through political history raises
fascinating questions about the cultural referent within which their
political currency can be apprehended, and about the political idioms
and symbols that the work engages through its bilinguality and
internationalism. Asking these questions of his texts can, in turn,
make close reading and contextualisation rather uncomfortable
tasks. To read Beckett's tales of dispossession, starvation, slow
death and torture in relation to French political history is also to
place them in dialogue with accounts of anti-colonial conflicts whose
memorialisation entertains an ambivalent relation to the Holocaust
and French collaboration with Nazism. This is an issue specific to
post-war literary cultures that is long familiar in the field of memory
studies: Michael Rothberg, in particular, has drawn attention to the
dangers of seeking to prioritise one historical narrative over others,
and his warning is pertinent to Beckett's work as well as other forms
of transnational writing.34 In Irish studies, Terry Eagleton, Jim
Hansen, Declan Kiberd, David Lloyd, Mark Quigley, Julieann Ulin and
others have inscribed the discussion of Beckett's historicity in a
clearer critical context, yet the political aspects of Beckett's writing
continue to pose difficult questions: there are intractable tensions
between, on the one hand, his overdetermined position within a
conservative and urban Protestant upper-middle class, and, on the
other, his elusive role in francophone and diasporic literary cultures
shaped by global movements of decolonisation. Such relation to the
political world brings to mind the concept of ‘cleft habitus’ coined by
Bourdieu in order to qualify a work permeated by compromise,
distance and ambivalence towards inherited social alliances.35 There
is another considerable rift, between the France and the Europe
Beckett got to know before 1938 as an affluent and leisurely
traveller, and the political realities he faced in wartime and post-war
France, as part of an everyday life marked by a progressive
‘impoverishment’ that was stylistic as well as economic.36
In French contexts, Beckett's trajectory does not intersect with
established narratives of political engagement either. Intellectual
historians have often privileged generational patterns, following the
model sketched out by Karl Mannheim, for whom political
engagement was firmly circumscribed by social class, generational
consciousness and singular periods of action specific to each
generation: Jean-François Sirinelli and Pascal Ory, for example, have
documented the ways in which generations of French writers
articulated and refined their political stance in the contexts of the
Popular Front, the Second World War and the Algerian war.37 Beckett
worked within different and often less established political spheres,
and his distaste for post-war Gaullism and distance from the French
Communist Party offer a stark contrast to the positions taken by his
contemporaries (he nevertheless continued to refer to the French
Communist Party knowingly, as ‘le parti’ or ‘le Parti’, like its
adherents).38 His identity as an Irish exile keen to proclaim his
persistent failure was also a political identity, deployed as a foil to
the assimilationist drive shaping French literary production and the
politics of ‘francophonie’. As carrier of a ‘green Eire passport’, as he
called it, he had no voting rights and was obliged to renew his
residence permit periodically; he is said to have queued up at the
immigration services without seeking to be exempted from common
requirements.39 This figure waiting patiently in the corridors of the
préfecture de police in Paris seems a world away from the celebrated
writer published by the Editions de Minuit, connected to influential
and politicised circles. Lindon's catalogue, dedicated to history,
psychoanalysis and the social sciences as well as literature,
redefined many intellectual parameters after 1960: notably, the
series ‘Arguments’ (created by Kostas Axelos in 1960), ‘Le Sens
Commun’ (edited by Bourdieu from 1964 onwards) and ‘Critique’
(founded by Jean Piel in 1967) contributed to the emergence of
radically new developments in literary and political theory, critical
sociology and psychoanalysis. On a broader political level, the
editorial strategy of the Editions de Minuit played an important role
during the Algerian war and, at later points, in response to
international campaigns against apartheid and the Israel-Palestine
conflict. Crucially, Lindon always perceived Beckett's work as his
stepping stone. At various points, he ascribed the very existence of
his publishing house to the day he first read the manuscript of
Molloy, concluding: ‘Nothing happened prior to that and everything
that happened afterwards follows from that’.40
Rarely have the French, Irish and global political coordinates of
Beckett's writing collided. The numerous press articles covering his
Nobel award, for example, mostly revolved around nationality
(French or Irish?) and belonging (anglophone or francophone?).41
More interesting, still, is the manner in which, at the time of the
hunger strikes in Northern Ireland, his work was momentarily
integrated into a precise political landscape after the deaths of
Bobby Sands and Francis Hughes. In 1981, in the French newspaper
Libération, Gérard Mordillat emphasised the parallel between the
acute distress of Beckett's characters and the situation of the
republican hunger strikers, deploring that, since 1969, Beckett's
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all. We thus have light discharges and severe discharges at different times, or, as the habit is
established, only the light or only the severe, the manifestation depending probably upon the number of
discharging cells and the importance of the exciting cause.
31 Traité de l'Épilepsie, etc., Paris, 1845, p. 55 et seq.

When the attacks occur in alarming frequency, as they sometimes do, the condition is known as the
status epilepticus. Leuret had a patient who had eighty in two hours, and Delasiauve reports the case of
a young man fifteen years old who had twenty-five hundred in one month. They may be so numerous as
to be apparently continuous. The patient remains in a state of coma (the status epilepticus), with very
high temperature. If he be not restored, he sinks into a deeper coma, and all the signs of collapse
manifest themselves. Bed-sores form, œdema of the lungs ensues, and the patient dies. Happily, this
condition of affairs is rare.

Delasiauve calls attention to the fact that the first two or three attacks that usher in this state do not
usually attract much attention, but the succeeding ones are so violent as to immediately suggest violent
consequences. In one of my cases the attacks, when they had once become numerous, were readily
excited by the least jarring, noise, or handling, just as we find in strychnine-poisoning or tetanus.

Irregular Forms.—There are occasional cases of psychical or masked epilepsy, the study of which is
intensely interesting. Such forms are characterized by perverted consciousness and a low degree of
volitional direction which may vary from automatism to the undoubted exercise of complex functions of
the mind, though badly co-ordinated. Mesnet's soldier, when subject to a paroxysm and apparently
unconscious, would perform a number of suggested acts in a rhythmical manner and with no
subsequent knowledge of the previous event: when started off by the word of command to march, he
would blindly go on, marking time when he met with an obstruction until stopped, or when a paper and
tobacco were placed in his hands he would proceed to roll an unlimited number of cigarettes.

Two cases of a more complex exercise of certain intellectual powers, while others were dormant, came
under my observation some time ago. One of them was a young man of twenty-three, who had had
irregular epileptic seizures for some years. He went to bed one evening as usual, arose, and
breakfasted with his family without creating any suspicion that he was at all unwell. He then went down
to his place of business, and after his arrival was sent to a distant part of the city for some tool. On his
return down town he stopped at a tobacconist's and became involved in a quarrel with one of the
persons in the shop. A policeman was called, who, more intelligent than many of his class, immediately
detected something queer about the man, arrested him, and afterward took him to Bellevue Hospital.
There he remained three days, and suddenly returned to consciousness and a knowledge of his
surroundings, but was entirely ignorant of his unfortunate experience. It is unnecessary to say his habits
were perfectly good and he was not drunk at the time of the quarrel or arrest. His last recollection was
that of going to bed the night before the day of his arrest.

Another case of unusual interest which came under my care, illustrating a phase of sensory epilepsy, is
worthy of reproduction:

C. O——, aged twenty-two, is a reporter attached to one of the New York afternoon papers, who
received a severe injury of the head when but three years old. He fell from the second story of an
unfinished building to the cellar, striking the upper and back part of his head upon a beam. He was
rendered unconscious, and remained so for a day or more. He recovered from the immediate bad effect,
but has suffered from severe general headaches, which recur every week or so, with an increase in the
amount of urine excreted. About six months ago he began to have epileptic convulsions of a violent
character almost every day, and sometimes more often. These were precipitated by excitement, and he
had a great many when worried about his wife at the time of her delivery. Upon one occasion he fell
down stairs and injured himself quite severely. The attacks were, as a rule, preceded by an epigastric
aura of long duration, and occasionally by a visual aura, and, according to the testimony of his
associates, he became strange and queer. When in such a dazed condition he would restlessly wander
about his office, and suddenly, without any cry, become convulsed. After the attack he slept soundly.
The bromides of sodium and ammonium and digitalis did little or no good, but the bromide of nickel
appeared to have some influence. During the past month he has had only two or three attacks, but
these have been of a quite irregular character. He told me that there were times when he felt like doing
himself an injury, and that he had impulses to kill some one else. His companions said he was irritable,
pugnacious, and easily thwarted, and his brother-in-law stated that upon several occasions he had
queer turns, when he would raise his hand to strike some member of the family—that he subsequently
knew nothing of his conduct, and when it was detailed to him he appeared greatly astonished.

Mr. O—— came to my office in company with a friend at ten o'clock in the morning of December 27,
1883. He had had one of his attacks at the newspaper office, of rather more severe character than
usual, at eight o'clock, with a psychical aura, during the existence of which he was very morose and
sullen. Upon recovery he was speechless, though he could communicate by signs. Upon his arrival at
my office his manner was composed and he appeared somewhat dazed. His pupils were dilated, but
contracted readily to light. I asked him one or more questions regarding his inability to speak, which he
perfectly understood, and when I gave him a pencil and a piece of paper he replied without difficulty in
writing. When told to make a great effort to speak he did so, and I thought I detected the word ‘To day,’
but he could not repeat it, though he tried and expressed great annoyance. He was unable to utter any
sound except a sort of groan, which could not in any way be taken as an element of speech. I examined
his larynx, but found nothing which could explain his impaired phonation, and I sent him to Dr. Asch,
who found absolutely no abnormal appearances to account for the speech difficulty. The patient could
not phonate, and though he made attempts to enunciate the vowel-sounds, and the vocal cords were
approximated, he made no orderly sound. Asch found a slight laryngitis of no importance.

The patient went home, and remained speechless all day, and was seen by my associate, G. de Forrest
Smith, in the evening. What occurred during and after that gentleman's visit is contained in his notes: “I
was called to see patient about 8.15 P.M. He was lying upon the bed, but had not slept; recognized me
and motioned that he could not speak, and I found that he could only say one or two words, and this
with the greatest effort, and so all my questions were put so that he could answer them by nodding or
shaking his head. He knew that he had had an attack in the morning, that he had seen Hamilton and
Asch, and recalled various incidents of the day, answering intelligently my questions in regard to them.
He indicated by motions that his inability to speak was due to a lump in his throat. When asked if he had
any trouble to think of the word he wanted, he shook his head, but shortly afterward hesitated in an
answer, and when asked if this was due to his inability to think of the word, said ‘Yes.’ Was asked if he
had any loss of power in either side, and he motioned to his right arm and leg, and said that he felt a
numbness and pricking on that side. On his grasping my hands with his, the right was perceptibly
weaker.

“At one time he seemed confused as to which was his right or left side, and put up both hands, and after
looking at first one and then the other in a puzzled manner, at last decided correctly, then smiled
apparently at his confusion.

“All this time he had been half lying on the bed. He now intimated that he was tired, put his head down
on the pillow and began to belch up wind, and as he appeared about to vomit I called for a basin; but
this was only the beginning of an attack; the muscles of the neck and right side assumed a state of tonic
spasm, the extensors predominating, so that the head was turned a little to the left and forcibly thrust
back into the pillow, and the right arm and leg were firmly extended. He remained in this position about
one minute; then, taking two or three full inspirations, put his hand to his throat and said plainly,
‘Something has fallen from there.’ On being asked ‘What?’ he replied, ‘A bone has fallen from my
throat.’ I told him it was well that the bone had fallen, as now he could speak. ‘Why,’ said he, ‘I have had
no difficulty in talking.’ On being asked why he had seen Asch, he said ‘Who is Dr. Asch? I never saw
any such person.’ Further questioning showed that all the occurrences of the day (except those which
had taken place immediately before the first attack) were an absolute blank, and he thought it still
morning. He asked the time, and I told him half-past eight o'clock in the evening. At this he seemed
much surprised and said, ‘Why, I went to work this morning; how did I come here?’ I then explained to
him that he had been ill. After further conversation he said he felt sleepy, and, after resting a few
minutes, he arose, put on his slippers, and came out into the room. He walked with difficulty, because of
the loss of power in the right side, which he said felt numb and sore, as if it had been pounded, also a
sensation of pins and needles. After the attack his mind was perfectly clear, and he could talk as well as
ever, and all that had happened before the attack in the morning he could remember perfectly well, but
the interval between the two was a complete blank. His inability to speak seemed due, not to lack of
knowledge of what he wanted to say, but rather to want of power to form the words, although there was
no paralysis of the vocal muscles. When he did manage to say a word, it was invariably the correct one,
but it was always done with the greatest effort. The day after the attacks he remained at home; the next
day he went to work, but his head felt heavy and confused. Two days after he complained of a pressure
on the left side and back part of the head; otherwise he was all right. At this visit he said that after I had
left him on the night of the attacks he intently thought, striving to recall the incidents of the day, and after
a time concluded he could remember being at Thirty-third street, but did not know how he got there. He
thought he could recall going to see Asch, but would not know him if he should see him. I then asked
him how questions were answered by him on that day; he answered he did not know, as he had not
thought of that; then, after a few moments' reflection, said he must have written the answers. He was
then shown some of the answers he had written, which he recognized, and by an effort of memory could
recall some of the incidents of writing them. He was still unable to remember anything that occurred
after his arrival home previous to the last convulsion.”

January 27, 1885: This patient subsequently suffered from several attacks in which the psychical
element predominated. His head presented a remarkable deformity, there being a prominence
posteriorly which might be compared to a caput succedaneum, only it was entirely osseous. The upper
margin was separated from the anterior parts by a deep sulcus.

Under such circumstances we find very often that acts of great violence are committed by such
epileptics for which they are entirely irresponsible. Two or three cases of the kind occur to me now. One
of them was a boy who always bit every one and everything—his family, the domestic animals, and
inanimate objects; another, a most dignified and lady-like woman, who violently struck different
members of her family; and within the past week a woman was brought to me who hurled a kerosene
lamp at a perfect stranger with whom she was quietly talking before the seizure was precipitated.
Numerous instances are related where individuals while in the masked epileptic state have wandered
for long distances and committed a variety of purposeless acts, and undoubtedly many of the
mysterious disappearances are of this order.

SENSORY EPILEPSY.—Some years ago Hammond referred to certain peculiar epileptic attacks in which
sensory manifestations were very pronounced. To this condition he gave the name thalamic epilepsy,
believing the condition to be one of the optic thalamus. Among the large number of unclassified and
irregular cases reported by various authors there are many so much resembling each other that I think
they should be relegated to a special place.32 The notable examples of Sommers, Bergmann, Tagges,
Guislain, and others belong to this category.
32 I shortly afterward, believing the term a misnomer, invented that in use: “On Cortical Sensory Discharging Lesions or Sensory
Epilepsy,” New York Med. Journal and Obstetrical Review, June, 1882; also see “A Contribution to the Study of Several Unusual
Forms of Sensory Epilepsy which are probably Dependent upon Lesions of the Occipital Cortex,” New York Med. Record, April 4,
1885.

The features of this form of epilepsy are (1) the expression of some hallucination (prodromal stage), or
hemiopia; (2) supraorbital neuralgia; (3) aphasia, formication; (4) slight loss of consciousness, and little
if any motor disturbance.

I may present two illustrative cases:

A few months ago I was consulted by a medical gentleman in regard to a patient who had for years
presented a curious train of nervous symptoms, which afterward assumed a form leading me to think
she might have sensory epilepsy. She would, in the presence of the gentleman who consulted me, who
was a personal friend of the patient and a medical man, stop short in the midst of an animated
conversation, look fixedly ahead, appearing momentarily lost, remaining abstracted for a short period,
possibly a minute, and on recovering herself go on, finishing the sentence she had commenced before
the seizure. At this time she constantly had hallucinations of a visual character, when she saw animals,
birds, figures of men and women, who approached her, as well as a variety of other objects. A common
hallucination, which had been repeated quite frequently, consisted in visions in which green leaves and
white rabbits and other objects familiar to her in childhood figured extensively. Upon one occasion, while
sitting in the drawing-room, opposite a door which communicated with the hall, she suddenly called her
companion's attention to the hand of a man which she saw clasping the baluster rail. The hand was
seemingly disconnected from the arm. She was somewhat agitated, and it was nearly half a minute
before the vision was dismissed. Sometimes she would call attention to the hallucinations before the
attack, but more often she became transfixed, apparently lost, and then recovering she described her
visions minutely. She has apparently been able to foresee the attacks and ward them off by a strong
voluntary effort. So far as can be learned, there is no hysterical element in the case, but her seizures are
more frequent at the time of menstruation. In a private note it is stated that “the family history of the
patient is very good, and she has always seemed remarkably healthy and robust, and has shown more
than usual intellectual ability. She has appeared to persons generally to be of a contented, happy
disposition.... At night, when she closed her eyes, she suffered from these hallucinations, especially
after a day of fatigue. Her pupils are usually dilated, but her color undergoes no change during the
seizure.”

The second case is one of a more complex type:

J. B——, a bright boy aged sixteen, was sent to me by F. H. Bosworth in April, 1883. He comes of
nervous stock, his mother being subject to epilepsy, and his father is an eccentric man who manifests
his mental peculiarities chiefly in a morbid restlessness and irascibility. There is a brother who is healthy.
The attention of the parents was first called to the boy's condition by his recital of a sudden attack which
occurred during the summer of 1882. While rowing upon a river he suddenly and completely lost the
visual use of the right eye, so that in looking at a number of ducks swimming near his boat he failed to
perceive those upon one side of the flock. This condition lasted for twenty minutes, and after a brief and
severe pain over the right eye he became unconscious, the unconsciousness being preceded by a
tingling and numbness of the hand, forearm, arm, and left side of the tongue. He has subsequently had
eight or ten of these attacks, of which the following is an example: Usually without any bad feelings,
physical or mental, he, while engaged in any duty or at any time, suffers a sudden unilateral blindness.
This is never gradual, and not like the form of amblyopia in which the visual field is gradually reduced.
There is some hemichromatopsia. It would seem as if the retinal anæsthesia was unequal, for while
usually the loss is complete and universal, it sometimes happens that there is only a limited loss. Upon
one occasion, while reading, he suddenly lost the printed matter of the right lower half of the page below
a diagonal line extending from the right upper corner to the left lower corner. There is never diplopia.
This deprivation lasts anywhere from ten to twenty minutes; meanwhile, a distal anæsthesia, coming
very gradually, involves at first the fingers of the opposite hand, and successively extends to the
forearm, arm, and other parts, as I have already mentioned. There seems to be analgesia as well as
anæsthesia, for a pin may be run into the muscles without producing pain, and upon one occasion the
gum was freely pricked without any discomfort to the patient. It invariably happened that the cutaneous
sensory trouble occurred upon the side opposite to the hemianopsia and neuralgia, and in the greater
number of instances the left side was that affected. The third stage of the attack consists in migrainous
headache of a very severe kind, and which sometimes lasts for an hour or more. There is a subjective
feeling as if the eye was pushed forward. This disappears with nausea and relaxation. More often he
loses consciousness when the anæsthesia reaches its limit, which seems to be the extension of the
anæsthesia to the gums. Occasionally there are slight convulsive movements upon the anæsthetic side.
While the attacks involve the left side of the body as a rule, it happens that when there is primary left
hemianopsia and right-sided anæsthesia the boy becomes very much confused in speech, and
sometimes is paraphasic, the trouble being but transitory. He is sometimes unable to speak at all,
though perfectly conscious and in possession of his faculties. No pupillary disturbance has been noticed
at any time. Upon two occasions there was a swelling of gums and tongue, which was not only
subjective, but perceived by the mother. Occasionally he sees prismatic colors and rays before the
blindness, but this has been only once or twice. During his early life he had attacks of slight numbness
of the hands and feet which were not thought much of, and he had headache as well. He has been a
somnambulist.
MORBID ANATOMY AND PATHOLOGY.—The literature of the experimental physiology of epilepsy is enriched
by the observations of a variety of careful students, among them Sir Astley Cooper, Kussmaul and
Tenner, Brown-Séquard, Nothnagel, Schroeder Van der Kolk, Pitres, Hughlings-Jackson, and the
followers of the localization school, as well as many others more or less distinguished.

The experiments of many of the early writers were directed for the purpose of ascertaining the relations
of circulatory variations to convulsive seizures, and the most notable were those of Burrows and
Kussmaul and Tenner. These latter produced compression of the carotid arteries, and instituted cerebral
anæmia by free and exhausting hemorrhages. As a consequence, the emptying of the cerebral vessels
was followed by a loss of consciousness and by epileptiform convulsions, and it was necessary to
produce the same result to compress all the great afferent vessels of the brain. The experience of
surgeons generally is, that ligation of the common carotid upon one side of the neck is sometimes very
apt to produce an alarming anæmia, with occasional convulsions, and sometimes fatal consequences.

The experiments of Hall, Landois, Hermann, and others, as well as those of the writers just mentioned,
show that carotid compression results in capilliary anæmia and venous hyperæmia, and that with
cessation of this pressure there is a sudden congestion of all vessels. The susceptibility of the brain is
greatest at its posterior part and between the optic thalami and the cord. When the bulb was subjected
to sudden changes in its nutrition—such, for instance, as followed the experiments of Hermann, who
ligated simultaneously the superior and inferior venæ cavæ of a rabbit—there were not only
convulsions, but various cardiac and other disturbances which were undoubtedly due to central
impairment of function. Kussmaul and Tenner conducted their experiments with watch-glasses luted into
the cranium—a procedure which, however, at best, is unreliable.

Brown-Séquard some years ago in part established an important pathological truth, the theory of
epileptic zones, and demonstrated in certain animals that bruising and injury of the great nerve-trunks,
especially the great sciatic, would give rise to epilepsy, and that irritation of certain tracts would
precipitate the paroxysms. He further announced that the progeny of animals in whom epilepsy had
been thus induced very frequently inherited the epilepsy of the parent. By some it was held that such
epilepsies were purely peripheral, and Brown-Séquard even believed in spinal epilepsy. His spinal
epilepsic theory has, for the most part, been explained by the anatomical researches of Hitzig and the
doctrine of interrupted spinal inhibition. In fact, many of the spinal epilepsies are examples of
exaggerated reflexes.

The epileptiginous zone theory, which, while it induced many to believe that the disease might have its
origin outside of the brain, gave rise to the false assumption that attacks with distal auræ were primarily
non-cerebral, has been discarded, and most observers have arrived at the conclusion that even in these
cases the first explosion is due to some cerebral cell-discharge.

Hughlings-Jackson's grand work has revolutionized the views held prior to his first published writings,
about twelve years ago. He believes that any part of the gray matter may, through over-excitability, give
rise to convulsive attacks.

The production of convulsions by cortical irritation is now an old story.

The experiment of Pitres and Frank33 bears upon the sensorial function of the cortex in showing that,
when the cortex is irritated, epileptiform convulsions follow, but if the exposed surface be subjected to
the ether spray the same irritation will only produce definite movements, but no convulsions.
33 Gazette des Hôpitaux, No. 38, 1883.

The investigations of Van der Kolk especially, and his followers, certainly give the medulla an important
place as the locus morbi of the malady; and it must be assumed, bearing in mind the existence of the
vaso-motor centres of Dieters and the presentation of symptoms indicative of disturbance at the floor of
the fourth ventricle, that the most important pathological changes must be looked for in this part of the
brain.
Jackson's cortical explanation is, however, fully in consonance with the medullary theory. If we study the
different stages of the attack, we shall find that there is probably a suspension of cortical inhibition—that
a derangement of the cortical cells or discharge may cause a resulting disturbance in the bulb. On the
other hand, a reflex irritation through the pneumogastric or from some distal part brings about the same
disturbance of equilibrium. There is anæmia due to irritation of the vaso-motor centre, an inhibition of the
great ganglion-cells, and a disturbance of function of the important cranial nerves. The primary anæmia
and unconsciousness are accounted for by this primary irritation of sympathetic filaments and vascular
constriction; the secondary hyperæmia is explained by the experiments of Kussmaul, which
demonstrated the succeeding congestion; or by irritation of the spinal accessory and contraction of the
muscles of the neck and compression of the large veins. The pupillary, ocular, respiratory, and other
symptoms indicate the disturbance of the nerve-nuclei in the bulb. The respiratory difficulty and the
interrupted decarbonization of the blood undoubtedly account for the secondary unconsciousness.

Van der Kolk34 in localizing the lesion in the medulla found capillary dilatations in the neighborhood of
the hypoglossal nuclei in tongue-biters. In epileptic patients who were in the habit of biting their tongues
during the fit the vessels were wider than in those who did not bite the tongue, on an average in the
course of the hypoglossus by 0.096; in the corpus olivare, which certainly here plays an important part,
by 0.098 mm.; and in the raphé by 0.055. In those who did not bite the tongue, on the contrary, the
vessels in the path of the vagus were 0.111 wider than in those in the first, Table A.35
34 “On the Minute Structure and Functions of the Spinal Cord,” by J. L. C. Schroeder Van der Kolk, New Syd. Soc. Trans.

35 TABLE.
Different Epileptics. Hypoglossus. Corpus olivare. Raphé. Vagus.
Table A—tongue biters 0.306 0.315 0.315 0.237
Table B—non biters 0.210 0.217 0.217 0.348
Difference +0.096 A. +0.098 A. +0.055 A. +0.111 B.

Nothnagel36 is of the opinion that the anæmia of the brain is not the cause of the convulsions, but that
the “excitation of the vaso-motor centre and that of the centre for the muscles are co-ordinate—that both
go on side by side, and are independent of each other.”
36 Ziemssen's Encyclopædia, vol. xiv. p. 268.

He by this theory explains the occurrence of those forms of petit mal in which there is loss of
consciousness without convulsions, and, on the other hand, twitchings before the coma.

The best argument in favor of this hypothesis is in Jacksonian epilepsy, when monospasms exist
oftentimes with a succeeding extension.

In those cases which are the outgrowth of migraine the pathological condition is probably an
exaggerated tendency to angio-spasm, the original impaired vascular tonus in the beginning giving rise
simply to pain and lesser troubles, while after repeated changes of calibre not only nutritive alterations
ensue, but hyperexcitability of the bulbar convulsion centres as well.

The labors of those who have endeavored to connect epilepsy with cerebral-tissue alterations have
been attended by nothing very definite or positive, so far as pathological explanation is concerned. The
post-mortem appearances have varied widely, and the only conclusion to be reached is that which
shows that almost any morbid gross alteration of the cerebral mass may be symptomatized by
convulsions, but such a production of paroxysmal trouble is much more likely to be the case, and in a
more definite manner, when the cortical motor-centres are subject to destructive disease or irritative
pressure. This is even not always the case, for numerous cases of injury of the paracentral lobe have
been recorded with no showing of resulting convulsions. The long list of autopsies which I will not here
consider show that an epilepsy may owe its origin to the pressure of a spicula of bone, or to the
pressure exercised by depressed fragments of the same—to tumors or adventitious products,
meningitis, cortical encephalitis, vascular degeneration, ventricular œdema, contusio-cerebri, and many
other morbid processes which result in rapid or tardy degeneration. Of course, in such cases the
genesis of the disease depends not so much upon the nature of the lesion as the location. The fruitful
collections of cases of Ogle and Jackson are full of examples of limited growth or disease involving the
cerebral cortex, while numerous cases collated by other writers show disease of the bulb or various
peripheral parts which have been closely connected with the growth and behavior of the affection.

Several able pathologists have independently and repeatedly found that sclerotic degeneration of the
hippocampal folds often existed. Delasiauve and Lébert first observed this lesion, but many modern
authorities—among them Meynert, Nothnagel, and Charcot—who have also found this appearance,
regard the change as of purely secondary, and consequently unimportant, character.

Tamburini37 reports a case of hemiplegic epilepsy with induration of the left optic thalamus and the left
cornu ammonis, in which aphasia existed. Pfleger38 and Henkes have also found the sole lesion to be
induration of the cornu ammonis. Of Pfleger's39 43 autopsies, atrophy and sclerosis of the cornu
ammonis were found twenty-five times, and it was noted that the extent of the morbid change bore
relation to the violence and frequency of the seizures.
37 Sallanzani, Modena, 1879, viii. 550-557.

38 Allg. Zeitschrift f. Psychiatrie, etc., Berlin, 1879, xxxvi. 359-365.

39 Ibid., lxxvi., and Arch. de Neurologie, No. 2, 1880, p. 299.

In many examples, especially where the disease has been found to be unilateral and associated with
more or less hemiatrophy, the autopsy disclosed a corresponding hemiatrophy of the brain. Many such
cases are reported. I have frequently found epilepsy in association with cerebral hypertrophy, and as a
symptom of cerebral tuberculosis it has long been recognized, and numerous cases are reported in
which for a long time the paroxysms were the only manifestations of the condition. In one of these
cases, reported by Luys,40 the bulb was found involved by tuberculous matter.
40 Archives gén. de Méd., 1869, ii. 641 et seq.

Convulsions have very frequently been noted in association with imperfect cerebral development, and
Echeverria laid great stress upon the hyperplastic increase in volume of certain parts of the brain.

Marie Bra41 has thus summed up her conclusions relating to the morbid anatomy of epilepsy:

“1. The mean weight of the brains of epileptics is less than the physiological mean.

“2. The cerebellum is greater than the physiological mean.

“3. There frequently exists an asymmetry between the lobes (not peculiar to epilepsy). The increase
of weight is sometimes found on the right and sometimes on the left side. Equality is the exception.

“4. In no form of mental disease (excepting perhaps general paresis, which is accompanied also by
epileptiform crises) have we met with so marked and constant a variation between the weights of
the hemispheres as exists in epilepsy.”
41 Referred to by Axenfeld.

Drasche, Green, Greenhow, Löbel, and others have detailed cases in which tuberculous deposits were
undoubtedly the causes of the disease.

Kussmaul and Tenner, Hoffman, and others have held that a stenosis of the superior part of the
vertebral canal may explain, through pressure upon the cord, the genesis of the attack, and Kroon found
asymmetry of the medulla oblongata.
The microscopical changes that have been found in brains where no gross lesion was apparent are by
no means distinctive. I have myself examined the brains of many epileptics with discouraging results.
The varying granular cell-degeneration, capillary dilatation, and exudative changes are common
enough. In several cases of cortical epilepsy I found more or less advanced degeneration of the great
cells in limited regions.

By far the most important and exact changes are those observed in the cases of sensory epilepsy. I
have elsewhere collected some continental cases. In brief, areas of occipital softening or degeneration
have been discovered in those cases with hallucination, sensory expressions, and hemiopia. In one
case attended by hallucination of smell the autopsy disclosed the following:

M. M——, was a stout Irish woman about forty years of age. She had suffered from a light form of
epilepsy dating from the tenth year, and resulting, as she stated, from a fall, when she struck her head
and was unconscious thereafter for some hours. No scar was visible, however. No satisfactory history
could be obtained regarding her early life and the first paroxysms. In the beginning these were rather
frequent, and she had as many as four or five a month. They afterward diminished in number and
severity, and for many years she had but three or four in the course of the year. They were not very
severe, and she was enabled to pursue her work as a housemaid, but did not keep her places for any
great length of time. She rarely bit her tongue, but usually frothed at the mouth and became livid and
convulsed for a short time. There was no history of one-sided spasms. As I have stated, I could gain no
accurate account of the previous attacks, except that she nearly always had an aura of a peculiar
character, which was a prominent feature of the seizure and very pronounced. She suddenly perceived
a disagreeable odor, sometimes of smoke, sometimes of a fetid character, and quite uncomplicated by
other sensory warnings; and afterward became unconscious, and remained so for two or three minutes.
She was invariably able to describe her sensations when she recovered, which she always did when I
asked her, comparing her warning to the smell of burning rags, to the smell from a match, and, as she
expressed it, it sometimes rose up in her head and choked her. She was under my observation for one
or two years, but eventually developed phthisis, and died, her attacks occurring from time to time until
her death.

Besides well-marked tuberculous lesions in the lungs, there was little of interest so far as the visceral
examination was concerned. The brain was removed and its peculiarities were carefully observed. A
great quantity of fluid was found, especially at the dependent portions of the membranes and in the
ventricles, while the dura was thickened and pearly in spots. There was a condition that might be
likened to a low grade of hemorrhagic pachymeningitis, and at the base of the brain old plastic changes
were found, there being adhesions, especially in the region of the middle lobes, but more particularly on
the right side and near the median line. The brain as a whole was small, and weighed forty-one ounces
and a fraction. The sulci were deep and gaping, and the convolutions were distinct. There was no
atrophy of the fore-brain convolutions, and no other pathological appearance was presented except that
found in the meninges, but at the lower part of the temporo-sphenoidal lobe of the right side an
appearance was found of an exceedingly interesting nature. At this point a decided shrinkage of tissue
was discovered, with depression and adhesion of the pia, the induration involving the uncinate gyrus
and parts of the adjacent convolutions, as represented in the drawing. No induration or softening of the
great motor tracts was observed, and the optic thalamus and parts adjacent were uninvolved, as was
the cord. An attempted microscopic examination, undertaken some months subsequently, was
unsatisfactory, because of the bad condition of the brain, the preserving fluid having been improperly
made. The olfactory nerves were not involved. The third frontal convolution was examined, but no
disease was found there. Consequently, it is to be inferred that no lesion of the external root of the
olfactory nerve existed.
 FIG. 27.

Lower Face of Right Hemisphere.

DIAGNOSIS.—Having spoken of epilepsy as in most instances a

symptomatic disorder, it would be proper to confine this section to
the differentiation of the simpler and more classical form of the
idiopathic disorder from certain purely eclamptic attacks or those due
to cerebral tumor or coarse degeneration. The epileptic attack itself
is to be considered from its time of happening, its duration, the
element of unconsciousness, its associations, and the antecedent
history of the individual. It may be confounded with the similar
phenomenon dependent upon cardiac weakness, uræmic poisoning,
toxic or alcoholic saturation, etc.

Of course, when we find recurring seizures with a certain amount of

what Carter-Gray calls quasi-periodicity, preferring perhaps the night,
the early morning, or only the daytime, we are almost sure of
epilepsy. This supposition is strengthened by the association with
attacks of petit mal. The duration of an attack, which may be from a
few seconds to several minutes, is also a guide, for in certain toxic
and other paroxysms the rule is for a succession of attacks to occur.

The question of consciousness is one that has drawn forth a great

deal of discussion, especially with reference to medico-legal cases. I
think the majority of clinicians are agreed that loss of consciousness
is an absolute belonging of epilepsy, yet there are cases in which the
lapse is scarcely perceptible. It is a dangerous precedent to
establish, for the convulsive symptoms in such cases are taken from
the epileptoid category. It is quite true that there are many hemi-
epilepsies in which the intellectual condition is one that may easily
be mistaken. I have seen numerous cases in which an apparent
conservation of consciousness remained throughout a slight
monospasm, but I do not feel at all sure of this; and in cases of
aborted or masked epilepsy there is a dual mental state which would
readily deceive the lay observer. The case of Mrs. S—— is an
example of this kind. After the obvious subsidence of the dramatic
and conspicuous feature of the fit she remained for hours and days
in a state of undoubted transposition, performing acts which required
something more than a high degree of automatism—going to the
table, talking about certain subjects which were suggested, with
apparent ease, but not connecting them intelligently with her
surroundings, as she would before and after the epileptoid state.
After a time she apparently resumed her normal state, but was
entirely unconscious of the happenings of her previous hours or
days, not even recollecting her simplest actions. Julian Hawthorne's
hero in Archibald Malmaison, though not drawn by a physician's pen,
suggests the state of which I speak, and it has the merit of being
based upon one of the elder Forbes Winslow's interesting cases.

When we find paroxysmal attacks occurring in individuals with

atypical heads, thick swollen lips, scarred tongues, and irregular
teeth, we may strongly suspect the patient to be epileptic. To these
we may add the appearance of the eyes, the fishy, lack-lustre
expression which betokens old epilepsy. The hands are clammy and
the skin mud-colored; the hair is dry and coarse; and the body often
has a death-like odor.

In children, certain mental peculiarities are to be inquired into.

Unnatural brightness or dulness—what may be called the clumsy
organization—is often present, and the muscular use is often
imperfect. We find that there is often but little nicety in walking, in
using the hands, in speaking, or after learning to write there is an
incapacity, with ever so much teaching, to develop a character or
style. Such children can never become ambidextrous. These little
points may seem trifling, but to the physician who carefully studies
his cases they may prove of great help. The history of the nights may
often lead to the discovery perhaps of a long-existing nocturnal
epilepsy. Incontinence of urine, blood upon the pillow, nightmares,
morning headache, and petechiæ betoken unsuspected night
attacks; and Le Grand du Saulk mentions the case of a young
Englishman who committed a purposeless crime and was
discovered to be epileptic, the diagnosis being confirmed by an
antecedent history of nocturnal seizures, and subsequent watching
resulted in the discovery of many night attacks.

As to special conditions with which the epilepsy may be confounded,

I may refer to cardiac weakness. It not rarely happens that simple
fainting attacks are confounded with those of an epileptic nature.
Such is the case more often in heat-prostration, when some rigidity
attends the loss of consciousness. The duration of such a state, the
condition of the pulse and color, however, will easily clear up any
doubts upon the part of the observer. The existence of a cause
should also be considered, and the fact that usually the epileptic
paroxysm is sudden, while a feeling of depression and feebleness
precedes the fainting attack, should be remembered. I may present
in tabular form the points of difference:

EPILEPSY. SYNCOPE.
Loss of consciousness Loss of consciousness follows
sudden. feeling of faintness.
Period of complete Unconscious throughout, no
unconsciousness usually convulsions.
short.
The existence of auræ of a The existence of preliminary vague
well-defined type. prostration, nausea, and irregular
heart action.
Often involuntary discharge Quite rare or never.
from bowels and bladder.
Patient usually falls into heavy After slight weakness patient is
sleep or is indifferent after anxious and worried, and quickly
convulsion. seeks relief.

The difficulty of diagnosis, however, is only in cases of petit mal.

There are light forms of auditory vertigo that may resemble
vertiginous epilepsy. In the former there is never loss of
consciousness, and the patient refers to the rotary character of the
vertigo. A history of antecedent attacks, tinnitus, aural disease, and a
certain constancy which is not a feature of petit mal, may be
mentioned.

There are cases, however, which are puzzling, and come under the
head of auditory epilepsy rather than auditory vertigo; and in these
there is a multiplicity of expressions, the auditory symptoms
predominating.

Of uræmic convulsions it is hardly necessary to speak. There is a

previous history of renal disease which the microscope and less
delicate tests will reveal, and clinically there is antecedent headache,
some stupidity, and not unrarely thickness of speech and
somnolence. There are some cases, however, which are obscure. I
have known patients with chronic renal disease—such as waxy
kidney, for instance—to develop a species of epilepsy, the
paroxysms recurring from time to time and behaving very much as
the idiopathic disease would; and their occurrence would mark some
imprudence in diet or exposure, and their disappearance an
improvement in the patient's general condition. The attacks were not
classical, inasmuch as there seemed to be but one stage of violent
clonic convulsion, preceded by intellectual dulness, and followed by
a semi-comatose condition which was far mere profound than the
somnolent stage of epilepsy. The movements were not accompanied
by a great degree of opisthotonos or pleurosthotonos.

Alcoholic and absinthic epilepsies are usually preceded and followed

by symptoms indicative of profound saturation.

The consideration of hysterical epilepsy may be found elsewhere,

but it may do to briefly refer to some cases which do not present the
phenomenon first described by Charcot and Bourneville. The
ordinary hysterical attack is never attended by loss of
consciousness, by any of the pupillary changes so constant in
epilepsy, by the mobility of the pupil between the attacks which is
present in a large number of true epileptic individuals. There are
never the succeeding changes of color, and the seizures are
commonly produced or attended by some emotional disturbance, or
are associated with ovarian disturbance.

Epilepsy is occasionally simulated by malingerers, and sometimes

the skill of the subject is so great as to even deceive the practised
eye. Prisoners, soldiers, and litigants may counterfeit an epilepsy,
and go through with great personal suffering to accomplish their
purpose. “Clegg, the dummy-chucker,” whose remarkable case has
figured in the medical journals, upon one occasion threw himself
from an iron platform to the stone floor of the jail, nearly twenty feet
below, to convince a suspicious physician of his honesty. The
simulator rarely bears close watching. The dilatation and contraction
of the pupil cannot be simulated, nor can the corneal or pupillary
insensibility. The fraud cannot voluntarily change his color, as is the
case in true epilepsy, and as a rule the thumbs of the impostor are
never flexed, as they should be. Suggestions for a purpose are
readily heard, and sometimes adopted, by the apparently
unconscious man. Gottardi42 lays great stress upon the use of the
ophthalmoscope as a means of detecting simulated epilepsy. He
calls attention to the frequency of retinal changes with facial
asymmetry and other evidences that suggest cerebral disease or
non-development. Gottardi has found that the pulse in true epilepsy
is always lower after an attack, but it soon reaches its normal
standard.
42 Abstract in Journal of N. and M. Dis., Oct., 1881, p. 843.

The differentiation of idiopathic epilepsy from that due to syphilis is

possible when we consider the element of pain. Besides the tibial
pains of syphilis, the epilepsy thus produced is often preceded by
intense frontal headache, while that of ordinary epilepsy follows the
attack. The syphilitic epilepsy is not attended by so great or
continued a loss of consciousness as the non-specific form, and the
movements are apt to be most violent on one side or the other. The
association of the attacks with various bodily signs, such as nodes,
old scars, alopecia, erosions, etc., and in connection with possible
cranial nerve-paralyses, will throw light upon its true character. The
paralyses referred to seem most frequently to involve the motor
ocularis, abducens, and patheticus. Syphilitic epilepsy, too, is quite
irregular in its time of manifestation, and is not unrarely followed by
aphasia; but the interparoxysmal mental state is one of extreme
dulness, memory being blunted and there being a peculiar hebetude.

PROGNOSIS.—Within the past quarter of a century the ideas of the

medical profession regarding the curability of epilepsy have certainly
undergone a change. The statistics of Bennett and others show that
since the introduction of the bromic salts the proportion of cures has
been decidedly increased. Nevertheless, the disease is a most
discouraging and troublesome one to manage, and especially is this
the case when it assumes the form of petit mal. The rapid recurrence
of light attacks is, as has already been said, very apt to lead not only
to mental enfeeblement, but is very often followed by very severe
paroxysms.

Epilepsy of a more or less constant form, in which the seizures

resemble each other, is far more incurable than that of variable type;
for example, we find that unilateral seizures are much more apt to be
associated with established cortical disease than when they are
general and simply explosive manifestations. It has been held that a
tendency to permanency is marked by a diminution in the extent of
the interval. This is by no means true. I have had cases under
observation for ten or twelve years in which attacks separated by
intervals of six months or one year marked the course of the
disease, in which frequent initial attacks were present. These cases I
regard as very bad so far as prognosis is concerned. I much prefer a
history of irregular and comparatively disorderly attacks. In female
subjects the menstrual influence is not always a bad factor. When we
are enabled to remove some production of an exciting cause in
connection with the catamenia the prognosis is more hopeful; but an
opinion must be expressed with great caution, especially in those
cases beginning at an early age and not after the establishment of
the menses. Traumatic cases are not always bad, but those in which
the element of heredity plays a part most certainly are, Herpin and
Gowers to the contrary; and though these cases for a time do well
under treatment, its good effects are not constant. Individuals with
misshapen heads, whose deformity suggests premature sutural
ossification, are not susceptible to the influence of treatment, and all
other osseous changes, such as exostosis, plaques in the dura, and
bony growths, whose existence can only be guessed at or inferred
from suggestive appearances elsewhere, give rise to a variety of
epilepsy which is beyond the reach of drugs. With symptomatic
epilepsies the case is sometimes different, for while the seizures
which arise from the irritation of a cerebral tumor are almost as
hopeless as the form I have just mentioned, we know from
experience that the epilepsy of syphilis and other allied diseases,
and those of toxic origin, with the exception sometimes of those
occasionally due to alcohol or lead, are curable. The meningeal
thickening of alcoholic origin or the encephalopathy of lead may be
the pathological bases of very intractable paroxysms.

So far as age is concerned, it may be stated that many eclamptic

seizures of young children which are due to well-recognized irritable
causes are promptly cured if there be no hydrops ventriculi or
preossification of the coronal sutures, and if the epileptic habit is not
established. The epilepsies of six or eight years' standing are not
encouraging from a therapeutic point of view, and those of advanced
life developing in aged persons are equally unfavorable.

The treatment of epilepsy due to heat-stroke is by no means

satisfactory, and, though the attacks are often separated by long
periods, they are apt to recur in spite of drugs.

Gowers has prepared several valuable tables which show the

influence of age upon recovery. He says: “The following table shows
that age has a distinct influence on prognosis. The percentage of the
unimproved cases to the whole is 30 (43:143::30:100). The
percentage of the cases commencing at each age arrested and
unimproved is stated, and between brackets is indicated the excess
of the arrested or unimproved cases at each period of life over the
proportion for the whole 30 and 70 per cent. respectively:

———Cases.——— ———Percentage.———
Unimproved. Arrested. Unimproved. Arrested.
Under 10 14 29 32.5(+2.5) 67.5
From 10-19 23 45 34 (+4) 66
20 and over 6 26 19 81 (+11)
43 100 30 70

Thus, the proportion of the cases commencing under twenty in which

arrest was obtained is considerably less than the proportion of cases
commencing over twenty, the difference amounting to about 13 per
cent. The period of the first twenty years of life at which the disease
commences has little influence, but the prognosis is little better in the
cases which commence under ten than in those which commence
between ten and twenty: arrest is more frequently obtained. The
cases which commence in women at the second climacteric period
are also obstinate, although not sufficiently numerous to be
separately given.”

He also finds, from an analysis of the same cases, the fact noted by
others, that the prognosis is favorable in inverse proportion to the
duration of the disease.

Attacks which chiefly occur in the daytime are much more amenable
to treatment than the nocturnal seizures, and especially is this the
case in the tongue-biting form. Sudden blows upon the head or falls
have been known in isolated cases to effect an amelioration in the
patient's disease, but these examples are rare.

The existence of an aura is much better than if none existed.

Death from the attack itself is rare, yet in the large pauper institution
with which I was connected for many years I have known of several
cases. More often the death results from asphyxia resulting from a
bolus of food which chokes the patient or from a fall in some
dangerous place—into the fire or elsewhere. Accidental death from
drowning is more common than any other form.

The status epileptica into which patients sometimes pass who have
had many convulsions is occasionally a fatal termination of the
malady, and is always a serious feature.

The influence of different epochs in life is worthy of consideration: of

menstruation, of marriage, of pregnancy, and of the menopause
there is much to be said. I have sufficiently spoken of the
establishment of the menstrual flow, and I would only add another
word of caution against giving a too favorable prognosis except in
those cases of very recent origin. Marriage appears to have very
little to do with changing the attacks, unless they be of an hysteroid
character. I have never known epilepsy to influence the course of a
pregnancy in any unfavorable way, and I think this has been the
observation of others. Gowers refers to cases in which the attacks
ceased during the time the mother was carrying the child.

The occasional bad influence of the pregnant state has been

illustrated by a case reported by Terrillon.43 This example was a
woman who had been the victim of epilepsy of hereditary origin since
her seventh year. At the commencement of menstruation her attacks
became periodic, and recurred every two months, and she had
several two or three days before the flow. Two pregnancies followed
several years afterward. During the periods they were increased in
number and severity, and occurred several times daily. She had
more attacks at this period than in all the time after delivery.
43 Annales de Gynécologie, June, 1881, p. 401.

I have found that the relief of uterine flexion or the establishment of

menstruation has exercised a decidedly modifying influence for the
better in several cases.

Sometimes the disease is interrupted by the menopause, but very

often in my experience it has changed in type and been followed by
mental degeneration.
The prognosis of the epileptoid mental state is serious in the
extreme, and even when in early life the attacks are aborted or
changed to perversion of the intellect or emotions existing as a
complication, the hope of cure dwindles almost to nothing.

The spontaneous cure of epilepsy is rare. Its course, however, is

more often interrupted by some intercurrent disease. Of 33 cases
observed by Delasiauve in which there was some complicating
disease, such as erysipelas, pneumonia, pleurisy, acute articular
rheumatism, burns and contusions, scarlatina, erythema, or the
condition of pregnancy, it was found that in 25 cases there was a
decided improvement (une heureuse influence), and in 8 only was
there no modification of the attacks. Axenfeld is disposed to believe
that acute and febrile disorders more decidedly influence the course
of epilepsy than those of a chronic nature. The influence of either
may be small or may diminish the number of attacks without curing
the disease.

TREATMENT.—The treatment of epilepsy depends so much upon the

form of the disease that no arbitrary rule can be laid down upon
general principles, and we must bear in mind the necessity for
removing the exciting causes if possible, the preservation of the
balance of cerebral blood-pressure and cell-equilibrium, and the
nutrition of the cerebral mass. It may be our purpose to remove
various toxæmic or cachectic states as well. As a minor division of
treatment we must consider the abortion of the attack when auræ
are detected. It has been the custom, I think among too many, to
manage the disease in an empirical manner, depending upon some
routine course of treatment, such as the indiscriminate use of the
bromides, for example. I am convinced that the intractable character
of the disease has come to be greatly exaggerated through failures
attendant upon the wholesale use of the bromic salts, without regard
to the indication in each particular case. It behooves us first to select
a reliable bromide, and then to give it with relation to the time of the
fit, its severity, and the condition of the individual. The importance of
this has impressed me very often. An equally divided daily dose will
not do a patient who has matutinal attacks the same good as will a
large dose at night, and in certain anæmic individuals the bromides
very often increase the attack. Then, too, the cases in which
seizures of petit mal predominate are not benefited to the extent that
those are in which the repetition of severe attacks is the feature. The
bromide should always be well diluted and given when the stomach
is empty or nearly so. The bromide of sodium is, to my mind, the
most serviceable salt, and when given alone or combined with the
bromide of ammonium is better than the potassic salt or the various
others. It should be carefully kept in solution or in waxed-paper
powders in a tight preserve-jar. As to its method of administration, I
much prefer the use of a solution which shall combine other
adjuvants which I will presently mention, and separate powders as
well, which may be used to reinforce the dose. The latter are to be
employed by the patient in the event of an unlooked-for series of
attacks, and are to be used to the point of producing mild bromism at
the time. In certain cases it is all-important to take into consideration
the condition of the heart. In some cases where there is manifest
and continued cerebral congestion, with full vessels and hard pulse, I
have found that the combination with chloral or aconite was
desirable. In other cases where the heart's action was irregular and
weak my experience with digitalis and nitro-glycerin or with
strychnine was most happy. In those cases that passed large
quantities of clear urine of low specific gravity the action of nitro-
glycerin and digitalis has been most prompt, and the same has been
true of epilepsies of migrainous origin.

There have been various methods of using the bromide suggested

which are more or less practical. The writers of a few years ago
suggested the prompt production of bromism—a state in which the
patient should be kept for a long time. This I strongly disapprove of,
not only because the mental and physical depression is a very
disagreeable and sometimes permanent condition, but because I
have found that the attacks are often increased after a time, though
at first they may have been suppressed. Others believe in giving the
bromides at intervals, with periods when no medicine at all is
administered.
For my own part, I am in favor of the establishment of a mild
bromism which does not extend beyond a slight anæsthesia of the
fauces or the appearance of slight acne. If I find it necessary to
increase the dose, I give cod-liver oil, iron, and bark or some of the
many preparations of the hypophosphites for a time; and they do not
diminish the specific effects of the drug to any great extent. In the
event of a series of attacks I direct the patient to take an extra dose
at such time as will anticipate the seizure.

This treatment should be kept up for at least two or three years after
the attacks have disappeared, and it may be even necessary to
continue a bromide course in a small way for an unlimited period.

If there be an hysterical element, or if ovarian excitement is

supposed to have anything to do with the attacks, the combination of
cannabis indica is strongly recommended. This suggestion holds
good in the cases where migraine is associated with the epilepsy, or
the latter is an outgrowth of the former.

Next to the bromides of potassium and sodium I have been very

successful with the nickel bromide. I find that it is retained with little
trouble, producing no gastric derangement if taken after eating. A
syrup prepared by most of the good pharmacists is preferable to any
other method of administering the salt. Quite recently Leaman44 has
reported two cases of severe epilepsy which were greatly benefited.
His conclusion is that it does most good in the form of the disease
when the attacks are separated by long intervals.
44 Med. News, Apr. 18, 1885.

The bromate of potassium, which has been used by Weir Mitchell45

and Hinsdale, may be worthy of a trial. It should never be given,
however, in larger doses than five or ten grains thrice daily. These
investigators found that thirty grains slowed the heart very
considerably, and forty grains produced watery discharges from the
bowels and drowsiness. In their hands, notwithstanding these
disagreeable effects, it controlled the seizures. The hydrobromate of
conia is a comparatively new remedy which has been