A system of practical medicine. By American authors. Vol. 5

by Unknown

¹³ Cor. Bl. Deutsches Gesellsch. f. Psych., Neuwied, 1855, ii. 35.

While I do not place much reliance on the claims that have been made regarding the frequent dependence of the disease upon preputial irritation, or that it may arise from phymosis or urethral stricture, it cannot be denied that some cases have originated in difficulties of the kind, and especially the former. Simmons¹⁴ reports a case of attachment of the prepuce to the glans in which a cure followed separation. Disease of the testicles in certain cases plays a part in its genesis, and Liégey¹⁵ details an epilepsy clearly due to testicular pressure. Some years ago I saw a case in which the pressure of an improperly applied truss, I am now convinced, had much to do with the development of the convulsions. The alleged sexual causes are many, and some of them are very doubtful. A fanciful continental writer, Montmeja,¹⁶ believes that sodomy explained the appearance of the disease in one of his patients.

¹⁴ Am. Journ. Med. Sci., 1880, N. S. lxxix. 444.

¹⁵ Gaz. méd. du Strasbourg, 1856, xvi. 105-107.

¹⁶ Rev. Photo. des Hôpitaux de Paris, 1873, v. 229-232.

The existence of vesical calculi as an exciting cause cannot be disregarded, and, while rare, the observations of Duncan,¹⁷ Muscroft,¹⁸ and one or two others have shown that the removal of a stone was followed by a cure of the epilepsy.

¹⁷ Ed. Med. Journal, 1868-69, xiv. 140.

¹⁸ Arch. Sci. and Pract. Med. and Surg., 1873, 1360.

Masturbation is a popular etiological factor. I really do not believe, even in face of the numerous alleged cases that have been recorded, that the habit of self-abuse often results in genuine epilepsy. So far as my experience goes, onanism is practised by epileptics as well as by healthy boys, and when indulged in to excess is due to the congenital moral deficiency which is so common, especially in hereditary cases. In rare examples the frequently-repeated act may give rise to a form of the disease of the nature of petit mal.

Gastric disorders have attracted much attention, especially from Paget, who speaks of a gastric epilepsy and reports cases. While I do not believe in the sole etiological influence of digestive derangement, I have too often witnessed examples in which disorders of this kind markedly influenced the precipitation of attacks and the duration of the disorder.