Giuseppe Ferrario and the epidemiology of apoplexy during the 19th century

OBJECTIVE: To analyze the pioneering research of Giuseppe Ferrario (1802-1870) on the epidemiology of apoplexy. To our knowledge, his work might have been the first to systematically investigate the epidemiology of cerebrovascular accidents, with the aim of shedding light on the underlying causes. METHODS: A detailed analysis of the essay "Statistics of sudden deaths, more particularly of deaths from apoplexy, in the city and neighborhood of Milan, from 1750 to 1834," published by Ferrario in 1834. RESULTS: Ferrario conducted a large retrospective study on 13,360 people who died from apoplexy during an 84-year observational period. Analyzed data showed that these events were more frequent among men and during winter. Apoplexy was reported as mainly occurring at the age of 60; an increase in mortality was observed in young women aged between 21 and 30 years, probably due to an abuse of bloodletting. Ferrario introduced the term "hereditary apoplexy," being one of the first to hypothesize hereditary components in cerebrovascular diseases. He also tried to investigate the role of social conditions in the etiopathogenesis of these events, analyzing marital and employment status and suggesting to his colleagues that cultural and economic factors should be further examined. CONCLUSIONS: Giuseppe Ferrario may be considered as a pioneer of modern science and epidemiology and his work deserves consideration within the history of neurology and of neuroepidemiology.