Reprint from the ALIENIST AND NEUROLOGIST, April, 1897. 
Preputial Reflex Epileptiform Convul- 
sions, with Report of a Case. 
ALEX. L. HODGDON, M. D., 
Dispensary Physician to Department of Nervous Diseases, College of Physicians and 
Surgeons, Baltimore, Md. 
of course, is only one of the many sources 
* of reflex epileptiform convulsions. A tooth fore ng 
its way through the gums, causing pressure on the sensi- 
tive nerve filaments; a splinter imbedded in the finger 
exerting deleterious nerve irritation, or an unaccomodated eye 
with its resultant irritant action, might all produce these 
reflex, epileptiform convulsions, or shall 1 not say the 
beginning of true e-pilepsy? And it seems doubtful if all 
epilepsies are not in a way reflex, from the irritable gas- 
tric nerves, constituting gastric epilepsy, to the tumor, caus- 
ing irritation by pressure on some one or several of the 
functioning centers of the brain, and by the resulting 
symptoms indicating their locality. Gray very aptly, and 1 
believe truly, says that Epilepsy is only a symptom.* 
“Our conception of epilepsy will be altered, if at the out- 
set we recognize the indubitable fact that epilepsy is but a 
symptom, just as is a cough or fever, so that epilepsies 
may be divided into those that are due to recognizable 
organic disease, those that are reflex and those that 
we may call idiopathic.” If due to some irritant which 
may be removed, why not very carefully try to prevent 
further convulsions in the teething infant, and circumcise 
the epileptic infant with phimosis, for there must be a 
.beginning to everything finite, and by removing sources of 
irritation you may prevent the formation of a permanent 
"‘Nervous and Mental Diseases,” Gray. 
1 2 
Alex. L. Hodgdon. 
lesion, or an intangible condition, such as habit epilepsy, 
both of which may in the end terminate the life of the 
epileptic, lapse into epileptic mania, and may finally 
follow the subject to his grave. We have somewhat of an 
illustration of this habit epilepsy in the rigor of malaria, 
those paroxysms which continue after the miasm has been 
removed from the system, which are dispelled, in some 
instances, by a mental impression, such as turning back 
the hands of the clock, till after the usual time for the 
chill; only the malarial paroxysms do not seem to produce 
a permanent change in the function of the nerve tissue, 
which may occur in epilepsy. May. we not possibly by 
administering proper doses of bromide of soda to the teeth- 
ing infant, and by circumcising the child with phimosis, 
prevent a life-time of misery? These matters should be 
attended to, and it would be well if all male infants were 
circumcised within the first month after birth, taking care 
to cut off all the skin that covers the head of the penis, 
so as to leave it completely uncovered, and so that no 
part of the head can be made to remain covered. If this 
were done it would prevent the occurrence of phimosis in 
the future, even if not present at that time. About the 
only objections that have been urged against cutting off the 
foreskin, is that it leaves the sensitive head of the penis 
constantly exposed to friction against the clothing and other 
rough articles, and another objection made is that the 
exposure to friction decreases to a certain extent the 
sensibility of this very sensitive head. It does come in con- 
tact with the clothing, after circumcision has been performed, 
but after some time, the mucous membrane of the glans 
penis becomes toughened and thicker, and so far as the 
decrease in sensibility is concerned, this is an advantage, 
as the act of coitus is prolonged, the glands of Tyson 
situated near the corona dry up, so that the glans penis of 
the circumcised individual remains dry and clean. 1 have 
performed the operation of circumcision many times, and 
have seen cases which have been operated upon by some 
inexperienced operators, which were about as badly off 
after the operation as before, on account of not having Preputial Reflex Epileptiform Convulsions. 
3 
removed enough skin. One should not operate on persons 
afflicted with haemophilia, unless the risk incurred from not 
operating, were greater than that from an operation. 
Kofelt has said that the glans penis is not exceeded in 
richness of nerves by any other part of the economy not 
excepting the organs of sense, and if so, is it any wonder 
if reflex epileptic convulsions occur in the case of the 
infant or adult afflicted with phimosis, with a quantity of 
smegma imbedded under the foreskin, on the delicate 
surface of the glans, which cannot be wiped off because 
the foreskin cannot be retracted, and is it not a wonder that 
trouble does not ensue in more cases? The case which I will 
report is that of W. T., aged, nearly four months, who had 
suffered since one month of age from epilepsy, having had 
a convulsion nearly every day, and has also exhibited a 
great deal of irritability, which he manifested by frequent 
attacks of crying. Upon inquiry I found that his urine had 
always passed away in drops, and dribbled away very 
slowly, also that he was passing considerable mucous by 
the anus. When 1 examined him, 1 found a very small 
preputial orifice, and was led to conclude that the convul- 
sions from which he had suffered, were probably reflex. 
As he had suffered from about three or four convulsions on 
the day when I first saw him, I resolved not to delay 
operating till the following day, but circumcised him that 
night. Since the operation of circumcision was performed 
he has passed his water without difficulty, and his feces 
appeared more natural. I circumcised him Saturday night, 
and he had'no convulsions on Sunday, but Monday after- 
noon he had three or four convulsions and a temperature of 
about Fah. 1 gave a little Bromide of Soda and Ace- 
tanilide, also small doses of Quinine Sulphate. On Tuesday 
the temperature was about 101°, and on Wednesday his 
temperature was normal. He has not had a convulsion 
since Monday, and seems to be very quiet and good-natured. 
It has been a long time since he was operated upon, and 
I have not heard of his having a convulsion since two days 
after he was circumcised.