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Brignell, Eva Australia (1863–1893)

by David Roth

Eva Australia Brignell was born in Woollahra, Sydney in 1863, the oldest daughter of Joseph and Annie Brignell. Afflicted by epilepsy as a child, her life was to end at Callan Park Hospital for the Insane at the age of 29. When Eva was admitted to the Gladesville asylum in August 1882, her father said that she had suffered a series of fits after an attack of sunstroke when she was twelve. Eva was now severely incapacitated. She was ‘dirty in habits’ (incontinent of faeces), refused to dress herself, prone to laughing and screaming without cause, and was sometimes violent.

Typically at this period, physical examinations of patients at admission to New South Wales (NSW) mental asylums were apparently superficial and brief. The examiner observed that Eva had a very dark complexion and black hair but did not mention her heart or lung condition. It was noted that she was very thin and in ‘low health’ (she weighed 40 kg), had a ‘vacant expression’ and was extremely demented. She could not understand or respond to questions. Eva had almost daily fits before presentation, often three times in one day. They were to continue, with varying frequency, for the remainder of her short life.

Epilepsy, a chronic disorder characterised by unprovoked and recurrent seizures, can have genetic or acquired causes. As in Eva’s case, it can be associated with cognitive dysfunction, behavioural problems and loss of memory. Indeed she was diagnosed with dementia on her admission to Gladesville. It is probable that her cause of death was status epilepticus, a common cause of death for epileptics at this period. It is defined either as a prolonged seizure lasting more than 30 minutes, or two or more seizures with recovery of consciousness. The increasing frequency of Eva’s fits in her last few weeks of life suggests that this condition was the probable cause of her death. Analysis of a cohort of 96 female patients admitted to the Ballarat Mental Hospital in Victoria in 1901 shows that about a third of them had died from status epilepticus and a third from other conditions by 1918.

Epileptics have been subject to discrimination and stigma since at least classical times. In the nineteenth century epilepsy was regarded as a form of insanity, not as a physical illness, and epileptics were thought to be fit subjects for care at mental asylums by their families and the authorities. Indeed many patients suffering from other neurological or organic conditions which caused changes in behaviour, such as General Paralysis of the Insane (a terminal form of syphilis), were typically confined in mental institutions when their families were no longer willing or able to care for them. In modern times, most cases of epilepsy can be effectively treated as outpatients. In Victoria in 1901, it was recognised that epileptics had special needs for constant supervision which could not be adequately catered for in the crowded asylums of the day, hence the confinement of all female epileptics at Ballarat asylum, where three dedicated cottages were provided. But no special provision was made in the NSW system.

Treatment of epilepsy at the time was focussed, as today, on attempting to reduce the severity and frequency of fits. From the mid-nineteenth century, various bromide compounds, a class of potent and relatively cheap sedatives, had been used for this purpose with some success. But by the 1880s, doubts about their safety and effectiveness began to accumulate. By 1900 some doctors called bromide treatment ‘not only poor therapy, but actual culpable negligence’, while one of the leading epilepsy experts of the day, the American William Spratling, claimed that they did more harm than good. It was noted that long-term usage of bromides could slow mental functioning to the point of dementia and cause skin eruptions in the form of a ‘bromide rash’. William Graves, another epilepsy specialist described bromide therapy as a ‘living death’ for the patient. L. P. Clark described their use as ‘culpable negligence’. A number of physicians complained that bromides were often administered without the necessary care and follow-up. Bromides became much less popular by the 1920s, as other drugs, such as barbiturates, came into use, but they were still used to treat epilepsy until the 1970s.

From the first month of her stay at Gladesville, Eva was treated with about 0.9 grams (half a dram) of tincture of belladonna, an extract of the berries of the poisonous deadly nightshade plant. It contains two effective sedative ingredients which can be toxic in large doses: atropine, which can relax muscle spasms, and scopolamine, an amnesiac which was used by some doctors at the time for pain relief, or more accurately for the forgetting of pain. The tincture has been used in alternative and traditional medicine for many conditions, such as arthritic pain, asthma, coughs and haemorrhoids. Eva’s fits decreased somewhat in frequency over the next month. But in October, the belladonna treatment was stopped and a new course of potassium bromide (0.9 grams) and cannabis extract (0.9 grams) was started. Eva was also prescribed Epsom salts, presumably to prevent constipation. This course of medication apparently continued until Eva’s transfer to Callan Park in early 1885. Some attempt was made to record the number of Eva’s fits in January 1883, but after that her documentation was both scarce and infrequent. Observations were only recorded at intervals of two to three months and mostly confined to ‘no change’ or ‘do’ (ditto). In April 1884, it was noted that Eva’s fits were ‘not uncommon and her health good otherwise’.

On transfer to Callan Park in February 1885, Eva’s handover notes say that she had now become ‘quiet and tractable’. As was the case at Gladesville in 1882, her physical and mental examination were cursory. Eva was observed to be in poor health and very demented. It was quite possible that her previous two years of bromide treatment had significantly contributed to this dementia. Her cannabis treatment was stopped, but her potassium bromide treatment was continued until January 1888. Observations of Eva’s condition were about as abbreviated and even less frequent than her Gladesville notes. There seems to have been no immediate change in her health or the frequency of her seizures after the stoppage of bromide. At the end of 1889, Eva was prescribed ferric perchloride. This medication had been used to treat epilepsy in the US and Britain since the 1830s. But there was no apparent change in Eva’s condition. In September 1890 an unusually long comment stated: ‘Hopelessly demented is very stupid & fatuous having fits frequently in feeble health & thin’. There were no further observations other than ‘no change’ or ‘the same’ until July 1893 when Eva ‘sank and died’ from epilepsy and exhaustion.

Eva’s experience at Gladesville and later Callan Park is perhaps representative of other epileptic patients who did not return to their families. My analysis of a small sample of fourteen deceased Callan Park patients who were diagnosed with epilepsy at admission between 1877 and 1920 suggests that they survived an average of four years. Brenda T* was an exception. She was admitted in a ‘stuporous state and died from chronic nephritis six days after arrival in March 1912, having shown symptoms of heart failure on arrival. Most of these patients, including Eva, received heavy and continuing doses of sedatives, including opium (laudanum), potassium bromide or tincture of belladonna. These medications had mixed results on the frequency of seizures. But it is also likely that they were used as a form of chemical restraint since some patients had episodes of violence after a seizure. It is possible that Eva’s time at Callan Park was a ‘living death’. Her working-class family, which seems to have been reasonably ‘respectable’, did not place a death notice.

Original Publication

  • People Australia, 27 May 2020

Citation details

David Roth, 'Brignell, Eva Australia (1863–1893)', People Australia, National Centre of Biography, Australian National University, http://peopleaustralia.anu.edu.au/biography/brignell-eva-australia-30374/text37671, accessed 11 August 2020.

© Copyright People Australia, 2012