Chris Gratien, Georgetown University
In the journals released by the late Ottoman and early Republican health ministry, one can find a variety of information from statistics regarding health and medicine to postings of positions. In the unofficial (gayriresmi) section of these journals, one also encounters articles by doctors that variously seek to introduce recent medical findings, argue for new methods of treatment, or discuss various issues from their own experience regarding the medical profession. These articles vary greatly in style and length but generally combine a number of practical concerns regarding science, medicine, ecology, and public health and safety.
This article from 1929 by a psychiatrist named İsmail Ziya falls into the category of combining knowledge of medicine and neurological disorders with the issue of public awareness. Through what I warn is a graphic account of an immigrant villager named Ali who inexplicably murdered his infant daughter, Dr. Ziya tries to emphasize the importance of monitoring the situation of patients with epilepsy. It is interesting because while the article is about medicine and written by a doctor, the subject is not scientific or medical understandings of epilepsy per se but rather the social implications of medical knowledge about disease.
In his introduction, he points to the common knowledge that in the midst of an epileptic seizure, it is usually the patient who needs protection and that people are socially conditioned to look out for the safety of those suffering from epilepsy who can injure themselves or maybe be vulnerable while they are unconscious. However, in this article he aims to address the hazards of small seizures that often go undetected and how unnoticed epilepsy in a patient can be a hazard to his or her surroundings as well.
In his introduction, he points to the common knowledge that in the midst of an epileptic seizure, it is usually the patient who needs protection and that people are socially conditioned to look out for the safety of those suffering from epilepsy who can injure themselves or maybe be vulnerable while they are unconscious. However, in this article he aims to address the hazards of small seizures that often go undetected and how unnoticed epilepsy in a patient can be a hazard to his or her surroundings as well.
The backdrop for this medical case is the killing of a child by her own father. The testimonies of Ali's family and the analysis of an investigator had led to the definitive conclusion that the crime was caused by insanity/madness (cinnet). The testimony of Ali's mother-in-law was particularly vivid:
During the day at around 3 o'clock Turkish time (alaturka), we were sitting with my son-in-law and daughter. My one and a half year old granddaughter was laying in the crib (salıncak). The child began to cry. His mother wanted to let her suckle, whereupon my son-in-law suddenly stood up. Smiling, he said "wait, I'll take a look" and picked her up by the neck and began to squeeze her throat. Her mother and I tried hard to get the child from his hand. He was holding on tight not letting go. The child's eyes bugged out, her face got purple, and her tongue came out. After that, he let her go. His wife wanted to attack him. Out of fear we ran outside shouting "somebody help us! (can kurtaran yok mu)" Soon after a villager came to our rescue and we went inside together. At that moment my son-in-law was sitting in front of the fireplace. He wasn't saying anything. I took my granddaughter in my arms. Something very soft went on my hand. I looked and saw that the child's intestines had come out, and her clothes were covered in blood. He had cut open her stomach with the sewing scissors, which were on the floor.
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| Topkapı Birmarhanesi entrance (1919) |
After being declared insane, Ali was brought to the hospital where Dr. Ziya began examinations. The first puzzling sign he encountered was that the patient would narrate the event, crying emotionally, "but it was as if he knew nothing about the crime (cürümden haberdar değil gibidir)." His narrative suggested that he was not entirely conscious when the killing took place. Then, as Dr. Ziya examined him further, it came out in their conversation that Ali had suffered a serious head trauma at age twenty, when his ox cart hit a bump and he tumbled out, landing on his head.
A few days later, after the Ali's mood had changed dramatically from laughing to being stern and terse, Dr. Ziya began to realize that his patient was suffering from epilepsy. In one incident, he was sitting in a chair when he suddenly began to grind his teeth and twist his clothes. This lasted about a minute, then he snatched the cigarette of the patient next to him and smoked it. Afterward, he remembered his own name but was not aware of where he was, and then he started talking about driving a cart. About two weeks later he had another episode. He ripped his jacket and sat looking stupified for two minutes. Some foam came out of his mouth but he did not fall down. Dr. Ziya did not find any bites on his tongue or signs of injury from the apparent seizure. He thus came to the conclusion that the man was suffering from small and atypical epileptic events that were not immediately apparent, making them extremely dangerous to those around him.
Dr. Ziya concluded that at the time the man had killed his daughter he was not conscious and was suffering from some sort of episode related to his epilepsy, although this seems difficult to ascertain. The larger point of his article, however, was that those with epilepsy and neurological disorders must be monitored more closely, even when there is nothing apparently wrong. He warns that in different circumstances or in the absence of a qualified interrogator, the event might simply have been interpreted as a murder. Of course, this extremely unusual case is intended as a graphic illustration of this fact more than a practical fear that epilepsy can lead to murderous fits. Concerns regarding the dangers of operating a motor vehicle or machine while suffering from epilepsy are perhaps more practical illustrations of this point.
What students of medical history might find most interesting about this article is the place it occupies at the center of different social understandings of a particular disease or disorder. As a medical practitioner, Dr. Ziya adopts the view that the man's epilepsy as the probable cause of his crime makes him not only innocent of criminal charges but also not to be placed in the category of insanity as originally had occurred. There have certainly been times and places where epileptics were regarded as insane, whereas most doctors today consider it a treatable medical disorder with certain known neurological bases.
Here the words of Hippocrates regarding epilepsy may be especially telling. In ancient Greece, epilepsy was considered as it has been elsewhere not so much as a form of madness but rather a sacred disease; seizures were a sign of some divine event taking place within the person's body. In his treatise on epilepsy, however, Hippocrates warned about the dangers of this view, saying that such a mentality would discourage people from search for certain causes for epileptic seizures, and if they managed to find some cause, they would probably cease to view the disease as divine.
While the scientifically-minded reader will certainly find that the spirit of Hippocrates's approach to disease resonates with our medical understandings today and the one adopted by Dr. Ziya in his pursuit of the neurological roots of a murder as opposed to offering a judgement on the sanity or for that matter morality of the patient in question, it may also be useful to keep in mind that this scientific understanding is no less culturally relative and may come with its own perils. Understandings of diseases and disorders that search for biological roots may also lead to troubling social outcomes. The conclusions of Dr. Ziya can logically lead to an understanding that epileptic people are biologically unfit for certain activities. In Nazi Germany for example, epilepsy was understood as a hereditary disorder that would have put individuals in the category of unfit that within that particular political culture qualified them for extermination. The prominent role of doctors in the Holocaust and other analogous cases is warning enough against the deployment of scientific distinctions in the creation of social categories. This is where the history of medicine can be especially useful, because it reminds us that ideas that are taken as such absolute fact today that we would not know where to begin to doubt them might elsewhere be considered entirely false.
Here the words of Hippocrates regarding epilepsy may be especially telling. In ancient Greece, epilepsy was considered as it has been elsewhere not so much as a form of madness but rather a sacred disease; seizures were a sign of some divine event taking place within the person's body. In his treatise on epilepsy, however, Hippocrates warned about the dangers of this view, saying that such a mentality would discourage people from search for certain causes for epileptic seizures, and if they managed to find some cause, they would probably cease to view the disease as divine.
While the scientifically-minded reader will certainly find that the spirit of Hippocrates's approach to disease resonates with our medical understandings today and the one adopted by Dr. Ziya in his pursuit of the neurological roots of a murder as opposed to offering a judgement on the sanity or for that matter morality of the patient in question, it may also be useful to keep in mind that this scientific understanding is no less culturally relative and may come with its own perils. Understandings of diseases and disorders that search for biological roots may also lead to troubling social outcomes. The conclusions of Dr. Ziya can logically lead to an understanding that epileptic people are biologically unfit for certain activities. In Nazi Germany for example, epilepsy was understood as a hereditary disorder that would have put individuals in the category of unfit that within that particular political culture qualified them for extermination. The prominent role of doctors in the Holocaust and other analogous cases is warning enough against the deployment of scientific distinctions in the creation of social categories. This is where the history of medicine can be especially useful, because it reminds us that ideas that are taken as such absolute fact today that we would not know where to begin to doubt them might elsewhere be considered entirely false.
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