Notes on the origins of Epilepsia and the International League Against Epilepsy

Authors


Address correspondence to Simon D. Shorvon, UCL Institute of Neurology, University College London, Box 5, National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, United Kingdom. E-mail: s.shorvon@ion.ucl.ac.uk

Summary

The recent discovery of archival material has shed interesting light on the origins of Epilepsia and also the International League Against Epilepsy (ILAE). The idea of an international journal devoted to epilepsy seems first to have arisen from talks between Dr. L. J. J. Muskens and Dr. W. Aldren Turner in 1905. A protracted series of subsequent letters between Muskens and a Haarlem publisher show how the idea slowly took shape. The committee of patronage, editorial board, and editorial assistants was probably first approached at the First International Congress of Psychiatry, Neurology, Psychology, and Nursing of the Insane, held in Amsterdam in 1907. At this meeting, the concept of an international organization to fight epilepsy (to become the ILAE) was also first proposed in public, again by Muskens. The concept of the ILAE was clearly modeled on another international organization—the International Commission for the Study of the Causes of Mental Diseases and Their Prophylaxis. This Commission had been first publicly proposed in 1906 by Ludwig Frank, at the Second International Congress for the Care and Treatment of the Insane. The proposed Commission and ILAE shared many features, aims, and personnel. Despite an auspicious start, the International Commission was prevented by personal and political differences from ever actually coming into being. However, the first issue of Epilepsia appeared in March 1909 and the ILAE was inaugurated in August 1909; and both have flourished and celebrate their centenaries this year.

Previous outlines of the history of the International League Against Epilepsy (ILAE) and its journal, Epilepsia, have been sketched in these pages (Muskens, 1938; Shorvon, 2007) and elsewhere (Meinardi, 1999), but many questions remained unanswered regarding the origins of both and the exact circumstances of their emergence. The recent discovery of two important series of letters and other documents from the contemporary literature, however, has now shed considerable light on these questions. In so doing, these findings have also drawn attention to the importance of the First International Congress of Psychiatry, Neurology, Psychology, and Nursing of the Insane, held in Amsterdam in 1907, as a focal point in the history of the ILAE and Epilepsia, and of the International Commission for the Study of the Causes of Mental Diseases and Their Prophylaxis as the influential precursor and model for the ILAE.

First International Congress of Psychiatry, Neurology, Psychology, and Nursing of the Insane

The 1907 Amsterdam congress ran from 2–7 September and attracted 750 delegates. From any vantage, it was an unusual convocation. For one thing, the event marked an effort to establish neurology as a discipline independent of general medicine (Franz, 1908). Indeed, there had been no international meeting of neurology since 1900, when the International Medical Congress, held in Paris, declared that it saw “no occasion to found (a separate) International Congress of Neurology.” Shepherd Ivory Franz (1908) noted that although few prominent physiologic neurologists were present in Amsterdam, the number of clinical neurologists was “large and important.” The 1907 meeting is also of special interest for the history of the ILAE, for it was there that two separate proposals—one to create an international journal dealing specifically with epilepsy, and another to form an organization to study and combat the disorder—converged for the first time. These proposals came to fruition over the next 2 years with the launch of Epilepsia, the formation of the ILAE, and the subsequent joining together of the two.

Epilepsia

Epilepsia predated the ILAE. Until very recently, that fact itself was unknown. But a series of letters archived in the University of Leiden have shed light on this topic, and have made clear, for the first time, how and why the journal came about, and who the key figures were. This archive contains 22 letters from L. J. J. Muskens to a Haarlem publisher, Jan Cornelis Tadema, of Erven Bohn (Muskens, 1905–1907). The letters show that it was Muskens, with William Aldren Turner from London, who conceived the idea of an epilepsy journal in 1905. “There is…talk,” Muskens wrote to Tadema on September 11, 1905, “of setting up an international journal for epilepsy, wherefore Dr Turner from London and I have taken steps and have received . . . approval from almost all well-known scholars in this subject.” Muskens (1872–1937) was a young Dutch neurologist (Eling & Keyser, 2003) and Aldren Turner (1864–1945) a leading epilepsy specialist in London. Both were to become major ILAE figures. Muskens generally found professional relationships difficult (Eling & Keyser, 2003) and seems not to have been particularly happy with the future plans, for he wrote on October 9, 1905 to Tadema: “England and America are collaborating but they exhibit somewhat too much a tendency . . . to take the lead.” Turner was quickly excluded and is not mentioned in the correspondence again (although he was on the first editorial committee 4 years later—see subsequent text). Progress was obviously also slow, and this must have frustrated Muskens, and possibly reflected his lack of collaborative spirit. However, on July 4, 1906, Muskens wrote that an international congress for neurology and psychiatry was going to be held in 1907 in Amsterdam, and during this congress he would attempt to appoint an international committee to discuss the question of a journal. A year later, on July 12, 1907, Muskens reported to Tadema that the plans for the journal were advancing and that following the Amsterdam congress, (William) Spratling of New York and (Gyula) Donáth of Budapest and other “well-known medics from Paris, London and Berlin (would) probably start taking more definitive steps.” The notion already was that the journal would be published quarterly, but the financing was uncertain, and some of the backers were not entirely convinced that the proposition would fly.

No details seem to have survived of what happened to Muskens’ committee. But things must have gone well in Amsterdam, for on October 3, 1907, a month after the congress, Muskens wrote to Tadema, “The matter is now well advanced,” and “five principal persons in our specialty . . . have agreed to be patrons: Hughlings Jackson, Binswanger, Raymond, Monakow and Bekhterev [(this was indeed a very impressive line-up). Also, we have accepted as editors: Nonne (Hamburg)], Mott (London), Donath (Budapest), Spratling (America) and Claude.” Sir F. W. Mott was a distinguished English physiologist and a Fellow of the Royal Society, but not especially involved in epilepsy. Muskens’ choice of him over Turner seems surprising, and in the event, Mott was not appointed as a member of the editorial committee when the journal was launched, although Turner was. When the journal was first published, the committee of patronage actually comprised Bechterew, Binswanger, Jackson, Luciani, Raymond, and Obersteiner (with Gowers and Dejerine replacing Jackson and Raymond on their deaths a few years later), and the editorial committee (comité de la rédaction) comprised Donáth (editor), Muskens, Turner, Spratling, Bruns, and Claude [with the latter two replaced several years later b Veit (Veith) and Munson].

We can find no further documentation relating to the journal until an advance notice of its publication was published in several American and European journals in 1908 (presumably on receipt of a publishers’ round robin). The earliest of these notices appeared in March 1908 in the Women’s Medical Journal (Anon, 1908a). A somewhat more detailed version was published in the Journal of Nervous and Mental Disease. This more detailed notice included a list of “collaborators and assistants.” Muskens had mentioned to Tadema on October 3, 1907 that he had recruited assistants, and this list shows how effective he had been in recruiting the leading figures of his time, not only in terms of the list of patrons and editorial committee, but also in relation to the editorial assistants, who were listed as: “Apelt, Stewart Grainger, Lejonne, Maes, Perusini, Southard, Agostini, Aschaffenburg, Alt, Alzheimer, Bastien, Batten, Brandos, Bruce, Ferrier, Gowers, Haskovec, Van Hamel, Hebold, Heilbronner, Henschen, Horsley, Jelgersma, Jellife, Kocher, Kowalewsky, Krause, Kure, Lewandowsky, Maxwell, Meyra, Nonne, Oppenheim, Probst, Cajal, Redlich, Stertz, Tukel, Voison, Weber, Salomonson, Wiersma, Winkler, Ziehen, and others”Anon (1908b).

Finally, in March 1909, after this long gestation, the first issue of Epilepsia appeared. All cannot have been smooth going in this interim period, however. First, when the journal did appear, Erven Bohn was not the publisher, and Tadema was not involved. In fact, the inaugural volume was put out by another publishing house, Scheltema and Holkema in Amsterdam. [An interesting connection between the firms exists in that the wives of the directors of each were sisters (S. A. A. Claeyssens, personal communication)]. What dissuaded Tadema from taking on the journal is not clear, especially as he had already published a small book of Muskens’ and had had extensive correspondence and meetings with Muskens regarding the journal. There was perhaps too long a gestation. Possibly Tadema found Muskens too difficult to deal with (the correspondence that remains contains only Muskens’ letters, not the replies), or perhaps he was simply worried about money. A second point to note is that Gyula Donáth was appointed first chief editor, not Muskens, who was recorded simply as being a member (and secretary) of the editorial committee. F. R. Mott was not on the committee, but Turner was, and there was a large Anglophone contribution. All this, one suspects, reflects the decreased role of Muskens. The list of editorial assistants had also diminished for some reason, and as published on the front cover of the first issue consisted of eleven persons: Apelt, Bramwell, Bratz, Grainger Stewart, Lejonne, Maes, Perusini, Southard, Stransky, Suchof, and Vogt (Fig. 1).

Figure 1.


Cover of the first issue of Epilepsia, probably published in March 1909 for the period January–March 1909.

Another point worth recording concerns the relationship between Epilepsia and the ILAE. It must have occurred to Muskens that there would be an advantage in connecting the two, at least at the time of the 1907 Amsterdam Congress, where he spoke on the desirability of setting up an international organization for epilepsy and was also simultaneously busy constituting the board of patronage of Epilepsia. Furthermore, an announcement in the Pester Medizinisch-Chirurgische Presse at the end of February 1909 by Donáth states explicitly that the journal (Epilepsia) intended to promote creation of an organization to fight against epilepsy (Donáth, 1909). At the third meeting of the ILAE, on September 3, 1907 (see subsequent text), it is recorded that a formal proposal by Pieter Hendrik Eijkman (in all probability stage-managed by Donáth or Augusto Tamburini, who chaired the meeting) that Epilepsia should become the official organ of the League, at least for the time being, was approved.

One interesting footnote in the history of Epilepsia is the slight confusion over its date of initial publication. The first issue is undated (marked simply, “1e Année” and “Fascicule 1”), but the next three carry the dates April–June 1909, July–October 1909, and October–December 1909. It seems likely, therefore, that the inaugural issue was January–March 1909.

The International Commission for the Study of the Causes of Mental Diseases and Their Prophylaxis

The sources for most of what follows are reports in the German and British neurologic and psychiatric literature of the time, and an unusually rich trove of letters found among the Ludwig Frank Papers at the Institute and Museum of the History of Medicine, Zurich (MHIZ).

In 1906, at the Second International Congress for the Care and Treatment of the Insane held 26–30 September in Milan, Ludwig Frank, a neurologist from Zurich, made a formal proposal to create an international institute to study the causes and prevention of mental illness in all its varieties. Frank’s proposal sparked a lively discussion (Bresler, 1909), and some in the packed audience were skeptical, in particular the noted criminologist Cesare Lombroso. But most delegates were enthusiastic, and the motion was carried “almost unanimously” (Ireland, 1907; Smith, 1910). The time was ripe for such an initiative, occurring as it did in the heyday of the internationalist movement in Europe: between 1900 and 1909 alone, 192 international nongovernmental organizations came into being (Lyons, 1963). In any event, the Milan congress was now empowered to nominate an International Commission for the Study of the Causes of Mental Diseases and Their Prophylaxis. Augusto Tamburini, a renowned psychiatrist and scientist who had worked with Luciani on classic studies of cerebral localization, was appointed as president and Frank as secretary-general. The Commission’s members, also accepted at or before the congress was over, represented 22 nations and included Domingo Cabred, Juliano Moreira, R. Percy Smith, J. H. MacDonald, Michel Catsaras, J. van Deventer, and Vladimir Bechterev (Smith, 1910)—among them many names that would figure several years later in the nascent ILAE. One of the Swiss participants offered the Commission the free use of his castle in Trevano, near Lugano, for its meetings (I Congressi di Milano, 1906). (For the sake of brevity, henceforth we shall refer to this commission in this paper by the acronym ICSCMDP, or alternatively as “the Commission.”)

The founding group agreed that whether to further the plan of an institute, “so simple in its organization, so lofty in its humane purpose” (Ferrari, 1907, p. 395) would be decided at the forthcoming Amsterdam congress in September 1907. In the event, the Amsterdam meeting served to confirm the proposal for the ICSCMDP and an eventual institute, and to hammer out a draft constitution, ambitious in its scope. It was agreed that the Commission would meet once a year and be governed by an executive committee to be elected every 4 years, hold international congresses that, where possible, would coincide with the International Congresses for the Care and Treatment of the Insane, and publish a quarterly bulletin—to be “sold to the public at the lowest price possible” and available to members for 20 francs. The bulletin would include not just original articles but also reports of national members, as well as rules and regulations regarding the insane. This of course was very like the program initially adopted for Epilepsia. The cooperation of governments as well as their resources would be solicited, and appeals for additional funds would be made to humanitarian organizations and wealthy individuals (Smith, 1910). The patronage of the King of Italy was solicited and granted (Minutes of the Session, 1907). The seat of the Commission was agreed provisionally to be in Bologna, later to be transferred to Zurich. The executive committee was chosen, to consist of Tamburini, G. C. Ferrari, Frank, van Deventer, Auguste Marie, Konrad Alt, and Arnold Pick.

The ICSCMDP convened again in Vienna on October 6, 1908 (Fig. 2), where during the course of a 3-hour meeting the delegates debated how to go about collecting statistics on the mentally ill and the urgency of setting up an institute to do so (where was an open question: Zurich, Paris, and Rome were all possibilities, with Zurich being Frank’s preference, owing to its “neutrality”); whether the Commission should directly undertake investigations; and how to obtain subsidies from governments to fund the work of the Commission and the bulletin. The sum of £200 per year per government was proposed. A revised constitution, now containing 24 detailed articles, was distributed. R. Percy Smith, on behalf of the British delegation, reported later that at present the expense of the Commission was “being defrayed by a small grant from the Italian Government, but we have no official authority for this statement” (Smith, 1910).

Figure 2.


List of attendees at a meeting of the International Commission for the Study of the Causes of Mental Diseases and Their Prophylaxis in Vienna in 1908. The signatories included Augusto Tamburini, J. van Deventer, Konrad Alt, and Ludwig Frank (the Commission’s founder). (Courtesy MHIZ.)

International League Against Epilepsy and the Inspiration of the ICSCMDP

Muskens attended the Amsterdam meeting in September 1907 and there made progress, as shown previously, toward founding Epilepsia. However, this was not all, and there is an account in the pages of the Neurologisches Centralblatt that provides the earliest reference to the setting up of what was to become the International League Against Epilepsy, stimulated by the example of the ICSCMDP. Toward the end of the session on the care of the insane at the conference, it is recorded that Muskens took the floor to ask whether, given Frank’s “eloquent appeal” in Milan on behalf of mental illness, it might not also be time to set up an international commission to study epilepsy (Bles, 1907). The reaction of his colleagues to Muskens’ idea is not recorded. Moreover, we have, to date, found no written record of subsequent discussions concerning the League, although they must have taken place. At some point, Gyula Donáth from Budapest assumed an important role, and the next mention of an international organization appears in the inaugural and second issues of Epilepsia in March and June 1909. In the first issue, the following notice (in English and in German) appeared:

On the occasion of the International Medical Congress to be held in Budapest August 29–September 4 (1909), neurologists, psychiatrists and all medical men, interested in epilepsy, are invited to a meeting, to consider the advisability of founding an International Association for the Study and Treatment of Epilepsy.

Gentlemen, who wish to take part in this meeting, are requested to send their names and address either to Prof. Julius Donath (Budapest, V. Bálvány-Gasse, 4) or to any of the other editors of this periodical. Later on a communication will be sent giving the time and place of this meeting. (Nouvelles, 1909, p. 123)

In the June issue (in French this time, which was the official language of the conference) it was announced that the meeting would be held at the Hotel Bristol. Plans had obviously been well laid, for it was also revealed that the National Association for the Study of Epilepsy and the Care and Treatment of Epileptics in the United States had nominated W. N. Bullard to attend, the Dutch association J. van Deventer and Brazil Juliano Moreira. Indeed, archives show that at a meeting of the American National Association toward the end of 1908, James Frederick Munson, the association secretary-treasurer, reported that he had received a request from the Dutch League Against Epilepsy for help in setting up an “international society to consider the problems of epilepsy” and had suggested “Buda-Pest as a place for the first meeting, at the time of the International Medical Congress next fall” (Munson, 1908, p. 145). The same players were involved variously in the ICSCMDP and in Epilepsia.

The inaugural meeting of the ILAE must have taken place on August 30, 1909 (see Shorvon & Weiss, 2009) with a subsequent second and third meeting 2 and 3 days later. Auguste Marie from Paris was asked to act as chair for the first two meetings during that week, and to report the proceedings to the psychiatry section of the International Medical Congress, and Tamburini as chair for the third meeting. In his report, Marie states that the initiative to hold the meeting came from himself, Donáth, Muskens, and van Deventer, although it seems likely that Tamburini was almost certainly also involved. Marie’s report to the psychiatry section of the International Medical Congress (a session also chaired by Tamburini, with Gaston Maillard) is published at the beginning of the third issue of Epilepsia (Marie, 1909), and is followed by minutes of the two subsequent meetings (see Shorvon & Weiss, 2009). Marie states, among other things:

The idea is to create an international action committee charged with centralizing all data related to the problem of epilepsy, its history, causes, and various manifestations in different countries. The data would be consolidated, then checked and compared, and a comprehensive inventory of regulations, laws, and private and public aid organizations could be created. Establishing what has already been done will make it easier to see what remains to be achieved; and on the basis of comparisons, we can come up with a programme.

Carrying out this data-gathering exercise will necessarily involve official contacts with public authorities. One can also imagine the need for a central clearinghouse arising before too long.

The plans and approaches of suitable institutions could be presented in special sessions during future conferences (for example, at Berlin in 1910 [the next in the series of Congresses on the Care and Treatment of the Insane]). The comparative data could be made the subject of comprehensive reports by an international commission that would divide up the work and would publish results, analyses, and comparative tables. We can even envisage a permanent office, and for that, government support would eventually be indispensable.

We wish to set up something analogous to the International Office of Hygiene (an early predecessor of the World Health Organization) or to the international psychological institute currently being created in Rome, under the patronage of the Italian government. Indeed, why should these existing entities not extend a hand to their daughter organization, the International League Against Epilepsy?

Obviously, such a vast and ambitious programme has the potential to engage the interest of philanthropists and intellectuals the world over.

Madness generally is governed by laws, national and international regulations, public and private aid organizations, in other words, it has codes and statutes. We would like to do the same thing for a class of unfortunates who up to now have been denied the benefits of society. Epilepsy may be a problem of heredity, or result from a variety of acute and chronic infections. Its associations span all the way from criminality to the limits of human genius. One hundred years after Pinel and his followers elevated prisoners to the dignity of patients, society must make for epileptics the same allowances and the same salutary efforts as it does for other disenfranchised persons. The League will devote itself to special projects on behalf of epileptics, and to finding a cure and means of prevention, as well as providing aid and social rehabilitation. Nor will the League neglect experimental research and comparative physiopathology, or laboratory work, which are essential for elucidating a series of problems as complex as those raised by the origin, evolution, and nature of seizure disorders, with their attendant range of somatic and psychic complications. (Marie, 1909)

At the same meeting, Tamburini is reported to have said, “Let me offer the committee for the study of epilepsy the support of the Commission already established in Rome for the protection of epileptics and for the foundation of an epileptic colony. The International Committee that is presently being proposed will also have the support of the International Commission to Create an International Institute for the Study of the Causes of Mental Diseases and Their Prevention (the ICSCMDP), of which I have the honour to be president. The two committees must work together on these questions of such profound import to science and humanity” (de Torday, 1910, 12: xliii, confirmed by Schweiger, 1909).

Marie went on say that the ILAE had the patronage of a committee consisting of Alt, Otto Hebold, Adolf Friedländer, Vladimir Bekhterev, Fulgence Raymond, Louis Landouzy, Robert Sommer, Wilhelm Weygandt, and Tamburini; a permanent office situated provisionally in Budapest; and an international action committee consisting of Tamburini, Hebold, Heinrich Obersteiner, Marie, van Deventer, Bernard Sachs, and Sommer, who would collaborate with the permanent bureau and with Muskens, secretary-general charged with recruiting members and with collecting the first round of international data. This committee would form a constitutional commission and would develop a general plan of research.

It is clear from the extremely detailed and precise report given by Marie, within a few days of the inaugural meeting, that the establishment of the ILAE must have been the product of considerable preparation, presumably by the quinquevirate of Muskens, Marie, Donáth, van Deventer, and Tamburini at least. Furthermore, the scope and range of activity proposed for the ILAE (not least the primary aim of collecting international health statistics to inform governments), the constitution and structure, and even the language used in Marie’s report closely mimicked that of the ICSCMDP. Thus was the ILAE founded, in tandem with the ICSCMDP and using the ICSCMDP as a model. Both organizations shared leadership, structure, and aims, and both had similar proposed programs of action.

The Subsequent Dissolution of the ICSCMDP and the Rise of the ILAE

There are no published reports of the nascent ICSCMDP meeting in Budapest or anywhere else in 1909. The correspondence at the University of Zurich for that year on the subject of the Commission comprises only a few communications from various parties asking what, if anything, was going on. In an undated letter (probably November) to James H. MacDonald, Frank complained that the earthquake in Messina and a changeover in the Italian government had stymied progress, at least in that country (Frank, 1909).

By 1910, it was evident that the ICSCMDP was in trouble. For reasons Ludwig Frank later attributed to politics (and it seems also laced with nationalism), the seat of the Commission had settled not in Zurich, as originally agreed, but in Rome, and Frank complained of being uninformed (Frank, 1910a). “People are always asking me where our institute stands,” he wrote to G. C. Ferrari, on February 7, 1910, “and…I always have to repeat the same thing: I don’t know.” He was not alone. The Commission next assembled in Berlin in October 1910 at the Fourth International Congress for the Care and Treatment of the Insane. The League was meeting there, too, on a separate day, although the participants overlapped. In the journal that he edited, Rivista sperimentale di freniatria e di medicina legale, Tamburini (1910) printed notices of the two meetings, one above the other. The Commission’s minutes show as present, among others, Tamburini, Alt, van Deventer, Marie, Ferrari, MacDonald, Binswanger, Sommer—all simultaneously members of the League.

Tamburini, in the chair for the ICSCMDP meeting, kept the agenda to the letter of the constitution, but the actual discussion centered on the difficulty of enlisting the interest and (financial) support of governments. The general consensus was that the meeting was a disaster. Frank’s own letters reveal a growing disillusionment with all talk and no action on the part of Tamburini, as well as a certain tension concerning the relationship of the Commission vis-à-vis the League.

To some extent this state of affairs no doubt reflected a recognized need at the time to distinguish epilepsy from insanity, just as neurology had previously wished to differentiate itself from general medicine (Salomone & Arnone, 1993). Oddly enough, based on the correspondence, the ICSCMDP needed the League more than vice versa. At this juncture van Deventer was a member of both the League and the Commission, but his primary concern was the Commission. Muskens, on the other hand, was singularly devoted to the League. “It would be advantageous,”van Deventer wrote Frank on November 30, 1910, “to take the epilepsy league, which…is a subpart of the institute, so to speak…under our wing,” and he suggested that Frank write to Muskens inviting the League to Zurich in 1911 to coincide with the Commission’s gathering (Fig. 3). Van Deventer had a broader motive, which was to forge a link between the Commission, the League, and the new International Bureau of Congresses in The Hague, about which he was very enthusiastic. On December 9, 1910, Frank responded, “I agree completely that the epilepsy league should interact with us, but to preserve our own organization, we should keep the meetings separate.” The Commission could not get its act together, however, and the 1911 Zurich meetings of both the ICSCMDP and the ILAE were rescheduled for September 1912 (Fig. 4). In the event, only the ILAE showed up, and without Tamburini. The ILAE subsequently began to flourish (a history of the early ILAE is to be found in Shorvon and Weiss, 2009).

Figure 3.


Letter from J. van Deventer to Frank proposing at the Commission to take the “epilepsy league…under our wing.” (Courtesy MHIZ.)

Figure 4.


Timeline of developmental stages of the ICSCMDP, ILAE, and Epilepsia. The exact date of the demise of the ISCSMDP is not known. Programs had been planned for Zurich (1911), Rome and Ghent (1912), London (1913), and Rome and Moscow (1914), (Rodríguez Arias, 1929), but there is no evidence that any of these meetings ever took place.

With no government endorsements forthcoming, the ICSCMDP’s budget was nil; its members could not agree on a permanent home; the bulletin did not happen; and even language was a bone of contention. Tamburini either made himself scarce or announced meetings impulsively “Our revered president is a little crazy,”Frank (1912) wrote to van Deventer on January 2, 1912. G. C. Ferrari, Frank’s co-secretary-general for the Commission, carried on a frenetic correspondence trying to preserve Tamburini’s reputation. People lost patience. “The German government is . . . not in the habit of incubating unlaid eggs,” Alt had written acidly to Frank on October 19, 1910, following the Berlin meeting (Alt, 1910). In January 1911, James H. MacDonald noted in the Journal of Mental Science, “Of the twenty members of the British [representation to the ICSCMDP] two have been removed by death, namely, the late Drs. Conolly Norman and W. W. Ireland. Of the remaining eighteen, eleven have not attended any meeting, and six of these have evinced no interest whatever in the work of the Committee, having neither attended meetings nor apologised for absence. It is desirable that any member who has no wish to remain on the Committee should inform the Secretary to that effect” (MacDonald, 1911). More grandiose than the League, yet less flexible and without the glue—even a semi-adhesive one—provided by a journal, the Commission limped along for another year or two, and then simply petered out.

In December 1928, Frank received a letter from Albert L. Barrows, assistant secretary at the National Research Council in the United States, seeking information about the ICSCMDP for a study the council was conducting about international associations. “The war completely destroyed all plans,” Frank wrote back. “But in my opinion the project would not have been successful even without the outbreak of the war, because every one of the nations participating wanted to have the seat of the institute.” The League of Nations was now trying to mount an effort in mental hygiene, he said, no easy task, “because the leading men of the different nations have as a rule too little or no interest at all for these questions so very important for the human race” (Frank, 1929).

The ICSCMDP failed, and the ILAE succeeded. The League met annually for the next few years and its journal flourished, and this year both celebrate their centenary. How curious it is that almost the same cast of characters should run one organization very well, and the other not. Apart from the greater hubris of the Commission and the international political bickering, one other obvious difference is the “organ.” The Commission’s planned bulletin was an integral element of its function, yet it never materialized. Had Epilepsia not already been in existence, given the precariousness of the League’s initial efforts, it is not clear that it would have fared any better. Now that the ILAE is turning 100 and in excellent health, Epilepsia would appear to have fulfilled the intention of its founders—to promote the creation and development of an organization to study and combat epilepsy—perhaps far beyond their expectations.

Note

In keeping with historical convention, in material directly quoted from early works, we have left the spelling as we found it, errors and all. Elsewhere, we have followed the spelling given by authoritative sources.

Acknowledgments

The two series of letters were uncovered by one of the authors (G. W.) who is indebted to Nathalie Briffod of the MHIZ and André Bouwman at Leiden University Library for their invaluable help and patience in tracking down these archives. We thank Dr. Ankie Moesker for translating Muskens’ letters from Dutch. Some of the text of this article is based on chapters written by the authors (G. W. and S. D. S.) for the Centenary History of the ILAE (Shorvon & Weiss, 2009).

We confirm that we have read the journal’s position on issues involved in ethical publication and affirm that this report is consistent with those guidelines.

Disclosure: We confirm that there are no conflicts of interest.

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