‘Infantile convulsions’ in the early nineteenth century. Abnormal brain blood flow and leeches, teething and gums’ scarification and food and purgatives: the historical contribution of John Clarke (1760–1815)

In this article, we discuss on the role of the British physician and midwifery practitionerJohn Clarke(1760–1815) in thecharacterisation of the various types of seizures and epilepsy and related phenomena (‘convulsions’) occurring in children. Inhis unfinished workCommentaries on Some of the Most Important Diseases of Children(1815), Clarke discussed the patho-physiology of convulsions and was the first to describe, 12 years before the French neurologistLouis Francois Bravais(1801–1843) and more than 30 years before the Irish-born physicianRobert Bentley Todd(1809–1860), the postictal paresis. Hebelieved that convulsions originated from changes in pressure within the ventricles as a consequence of abnormal blood flowto the cerebral vessels. In keeping with the theories of his time (e.g. Baumes 1789, 1805; Brachet 1824), Clarke believed thatteething was a major cause of‘infantile convulsions’. His proposed remedies ranged from scarification of the gums to ammonia,application of leeches, cold water, and purgatives. The use of antispasmodics, quite popular at the time, was instead questioned.In hisPractical Observations on the Convulsions of Infants(1826), the London practitioner and midwiferyJohn North(1790–1873) deeply criticised Clarke’s view that convulsions arise inevitably as a consequence of organic brain lesions. North inferredthat the results of autopsies of children who had died of convulsions revealed no brain damages, and claimed that cerebralirritation could also occur as the effect of distant lesions. Other Clarke’s contemporaries (e.g.Jean Baptiste Timothée Baumes—1756–1828) inferred that all convulsions reflected a hereditary diathesis, which rendered children (especially those with softerand limper nervous and muscular tissues!) extremely sensitive to all sorts of provocation that could trigger convulsions, includingbad digestion (more pronounced at the time of teething), loud noise, and bright light. Although almost every aspect of Clarke’sview on convulsions was subsequently proved wrong, his (and his contemporaries’) work provides fascinating insights into thetheories and therapies of seizures, which were popular at the dawn of modern neurology.*Martino Ruggierim.ruggieri@unict.it1Department of Neurosciences, Biomedicine and MovementSciences, University of Verona, Verona, Italy2Department of Neurology, Franz Tappeiner Hospital, Merano, Italy3Unit of Neurology, Department of Clinical and ExperimentalMedicine, Università Politecnica delle Marche, Ancona, Italy4Department of Neurology, Christian Doppler Klinik, ParacelsusMedical University, Salzburg, Austria5Center for Cognitive Neuroscience, Salzburg, Austria6Public Health, Health Services Research and HTA, University forHealth Sciences, Medical Informatics and Technology, Halli.T, Austria7School of Public Health, Department of Health Sciences, Universityof Genoa, Genoa, Italy8Unit of Rare Diseases of the Nervous System in Childhood,Department of Clinical and Experimental Medicine, Section ofPediatrics and Child Neuropsychiatry, AOUBPoliclinico-VittorioEmanuele^, University of Catania, Via S. Sofia, 78,95128 Catania, Italy9Department of Clinical and Experimental Medicine, Section ofHistory of Medicine, University of Catania, Catania, Italy10Department of Health Sciences, Section of Medical History andEthics, University of Genoa, Genoa, Italy11Unesco ChairBAnthropology of Health—Biosphere and HealingSystem^, University of Genoa, Genoa, ItalyChild's Nervous Systemhttps://doi.org/10.1007/s00381-018-3769-y