EPILEPS Y FROM PERIPHERAL 
IRRITA TION. 
CURES BY REMOVAL OF AN INJURED AND DISEASED TESTICLE 
AND A FOREIGN BODY FROM THE NOSE. 
BY 
GUY HINSDALE, M. D., 
Assistant Physician to the Infirmary for Nervous Diseases, and to the Presbyterian Hospital, 
Philadelphia; Instructor in Physical Diagnosis in the University of Pennsylvania. 
THE AMERICAN JOURNAL OF THE MEDICAL SCIENCES, 
FROM 
June, 1889. Extracted from the 
American Journal of the Medical Sciences for June, 1889. 
EPILEPSY FROM PERIPHERAL IRRITATION. 
CURES BY REMOVAL OF AN INJURED AND DISEASED TESTICLE AND A 
FOREIGN BODY FROM THE NOSE.1 
Guy Hinsdale, M.D., 
ASSISTANT PHYSICIAN TO THE INFIRMARY FOR NERVOUS DISEASES, AND TO THE PRESBYTERIAN 
HOSPITAL, PHILADELPHIA; INSTRUCTOR IN PHYSICAL DIAGNOSIS IN THE 
UNIVERSITY OF PENNSYLVANIA. 
The following'case, which I was'called to see in New Jersey, and in 
which I have been much interested, was admitted by Dr. Weir Mitchell 
to his ward in the Infirmary for Nervous Diseases; he has kindly placed 
it at my disposal. The following history was elicited: 
Case I.-Father's and mother's family healthy and free from nervous 
disease. Mother still living. The patient, a sailor by occupation, has 
always been a healthy, robust man ; he is a Swede, forty-three years of 
age, and weighs two hundred and fifty pounds. He has lifted nine hun- 
dred and fifty pounds. He is a man of intelligence, clear-headed. On 
February 17, 1888, while loading a vessel, a bale of hay fell ten feet 
from the dock to the ship's deck, striking him on the right hip and 
forcing him to the entrance of the main hatch, the edge of which is 
elevated about a foot above the deck. On this edge he was caught; 
the pressure was expended in a line running from between his legs to 
the left shoulder. His right leg was broken. There were severe bruises, 
but no break of the skin. 
The patient cannot say that his head was struck ; he was, however, 
unconscious for half an hour or an hour, and was carried to the cabin. 
He had probably no convulsion at that time. The fracture was set by a 
surgeon, and he was sent to the United States Marine Hospital at Port- 
land, Maine. There was great pain in the back and in the left side, and 
the patient had cramps from the start. The muscles of the left side of 
the abdomen were drawn up in knots, he says, the size of two clenched 
fists. He does not think the abdomen was discolored. There was no 
fever. The pain in the side was relieved in about ten days, but remained 
in the back. 
From the start it was noticed that the left testicle had been forced 
out of its position ; it could not be felt. The right one remained intact. 
On the eighteenth day he was seized with rather sharp pain running 
along the left groin into the scrotum. At this time he began to feel 
queer in the head and left shoulder, elbow, hand, heart, and thigh; not 
Read before the Philadelphia Neurological Society, March 25,188! 4 
HINSDALE, REFLEX EPILEPSY. 
Thirteen years later he had his first fit. It came on without aura or 
other warning. He made some guttural noise, had convulsions of arms 
and legs, with movements of the eyes. During the attack he was per- 
fectly unconscious. He had three convulsions the first night. Duration 
about half an hour, and was very drowsy afterward. 
One month later he had a second attack similar to the first. Spasms 
have recurred at intervals of from six weeks to three months during the 
last fifteen years. The patient has had as many as eleven in twenty-four 
hours. 
Examination shows an atrophied testicle about one-sixth the size of 
the right. Cremasteric reflex less in the right side than in the left. 
There is no aura or feeling referable to the testicles. Pressure on the 
testicle does not give pain in the head. Sexual power is as good as ever. 
It may fairly be questioned whether in this case the injury and the 
epilepsy are in the relation of cause and effect, but I think that, in the 
absence of other known exciting causes, and coming on at the age of 
thirty-six, especially in view of the case first described, this may reason- 
ably be placed in the same category. 
Dr. Weir Mitchell has kindly given me the following communication : 
Case III.-The record of the case of epilepsy, which was cured by 
the removal of a diseased testicle, has recalled to my mind a case, of 
which, unfortunately, I have no notes, although I retain a vivid remem- 
brance of it. 
Many years ago, whilst in attendance as physician at the Pennsyl- 
vania Institute for the Blind, I was called upon to see a blind girl about 
seventeen years of age who was afflicted with epilepsy. The attacks 
were violent, so that she bit her tongue. After each attack she became 
unconscious and remained so for some hours. The attacks came on at 
intervals of not less than two days, and were increasingly frequent when 
first my attention was called to the condition. The girl was of rather 
weak mind, and had the history of a fall upon the head, to which the 
attacks had been attributed. A very careful examination revealed the 
fact that she had a purulent discharge from the left nostril. In the effort 
to treat this it was discovered that that side of the nose was completely 
occluded by a foreign body. This was extracted piece by piece, and was 
found to be a bean, which, in some foolish play, had been pushed up the 
nostril and lodged there. It had at one time begun to sprout, but this 
growth had manifestly been arrested by circumstances unfavorable to 
its increase. 
The removal of the bean and washing out of the nostril with proper 
astringent solutions resulted in complete cure of the fits. As I remember 
it, she had one or two after the removal of the foreign body, but no 
more. These attacks were most positively of an epileptic nature, and 
they had nothing about them of hysterical quality. They had long been 
considered incurable. The case is so simple that there is really no more 
to tell than what I have here so briefly placed upon record. 
Of course, these three cases ought to be distinguished from idiopathic 
epilepsy. They may be designated as eccentric or peripheral convul- 
sions, and belong to the same category as dentition-convulsions, fits from 
worms, etc. HINSDALE, REFLEX EPILEPSY. 
5 
In the case of the sailor reported it took two months for the changes 
in the testicle to produce that degree of irritation which caused the fit. 
There was no special proclivity in the disposition of the patient. The 
injured organ, however, produced not only in the afferent nerve but in 
the centre to which it is attached some interstitial change. Just what it 
is we are unable to say, but it was sufficient to produ.ce motor impulses 
along efferent nerves. 
The injured and diseased testicle was the cause of the convulsions, 
but the accompanying irritation was certainly not of a high inflamma- 
tory character, the organ being over tender but not actively painful. 
Peripheral irritations as causes of epilepsy are not necessarily accom- 
panied by sensation. For this reason it is imperative in all cases of 
apparently causeless repeated convulsive attacks to seek out the points 
of irritation. It is the treatment of these cases for which there are 
tangible causes that yield the brilliant results. In an interesting com- 
munication made 'about one year ago on the subject of epilepsy from 
dental irritation, Dr. A. P. Brubaker recorded such a case, successfully 
treated by extraction of a carious tooth, and accounts of fifteen similar 
cases were collected by him. 
In the case of the sailor with the injured testicle it was a matter of 
uncertainty whether or not the epilepsy had not become so engrafted 
upon the brain as to continue even after the operation. No doubt many 
cases of so-called idiopathic epilepsy and Jacksonian epilepsy have been 
reflex in their origin. In consequence of some intense reflex excitation 
epileptic paroxysms have come on, the cerebral cortex has discharged in 
a particular way, and this habit of discharge has been fixed upon certain 
regions of the cerebrum; and in these cases, even after the subsidence of 
the reflex excitement, and in some cases after the removal of the reflex 
cause by operation, the epilepsy which has been imposed upon the cen- 
tral nervous system persists. Such a case has been recorded by Dr. Mills.1 
In that instance the patient had fallen at the age of four, striking the 
head and injuring it. Epilepsy supervened; the convulsions were some- 
times without unconsciousness, and always began in a finger of the in- 
jured hand, and extended in a peculiar order. At the age of fifteen the 
finger was operated upon and a neuroma found by Dr. S. W. Gross. A 
second operation was deemed necessary and was performed by Dr. 
Hearn. For at least one year the patient had the seizures as frequently 
as before. They then began to diminish in frequency. At this time, 
several years since the operation, it is reported that for two years the 
patient has had no convulsion. 
These cases are especially interesting in view of the question of re- 
moval of the cortex. The fact that the epilepsy has been originally of 
1 Trans. International Congress, 1888. 6 
HINSDALE, REFLEX EPILEPSY-. 
reflex origin does not render a cortical operation improper, but it is, of 
course, not to be considered until a peripheral operation has been tried. 
There is in the class of reflex convulsions a form called pleuritic epi- 
lepsy. It was first described by M. Maurice Raynaud, of Paris, in 1875.1 
It was found that the injection of weak solutions of iodine, chloral, car- 
bolic acid, etc., into the pleural cavity in the treatment of chronic pleu- 
risy was followed by convulsive attacks in certain cases. A partial 
hemiplegia has also followed such injections, and in other cases followed 
the convulsions. These reflex convulsions have proved fatal; the result, 
however, not at all due to absorption of the substances injected. It 
is stated that after the injection suddenly the face becomes very pale, the 
respiration is suspended, and the pulse is very small and scarcely felt. 
Generally the spasms are first confined to the face or arm of the side of 
the injection, but soon they become general; at first tonic, then clonic 
and accompanied by profound unconsciousness. 
Study would doubtless bring to light many instances of the peripheral 
excitation of the spasms in so-called centric or idiopathic epilepsy. 
Echeverria believed that, on the whole, everything warrants us in think- 
ing that in epilepsy the spasm is always induced by peripheral irritations, 
generally unfelt or not easily discoverable, and that, even without re- 
moving the original lesion of the disease, the fits may be subdued as long 
as all source of disturbance be withdrawn from the nervous system. 
He gives in a total of 286 a list of 28 cases of epilepsy from peripheral 
irritation, many of which, however, should strictly not be admitted to 
that class. 
Herpin, whose work was published in 1852, gives no cases as from 
peripheral irritation in his list of 68. 
Reynolds classifies epilepsy from dentition, indigestion, venereal ex- 
cesses, dysentery, etc., under eccentric irritation, and records 16 cases. 
Hammond in 572 cases gives 21 as from dentition, 24 from blows on the 
head, and 4 from peripheral wounds or injuries. 
Injuries of the testicles have produced reflex paralysis as well as 
epilepsy. Such an instance of paralysis from peripheral irritation has 
been recorded by Dr. Weir Mitchell3 as follows: 
A sergeant was shot in the right testicle ; the organ was almost en- 
tirely destroyed by the ball. He fell without pain, believing himself 
wounded in the back; he then became senseless, but recovered in a few 
minutes and could walk. The right foot, however, dragged. There was 
paralysis of the right anterior tibial muscle and peroneus longus. 
As a remedial measure for epilepsy in general castration has been ad- 
vised, and, according to Gowers, has been performed without effect. 
1 H. C. Wood : Nervous Diseases and Their Diagnosis, p. 110, 1887. 
2 Echeverria : Epilepsy, p. 206, New York, 1870. 
3 S. Weir Mitchell: Paralysis from Peripheral Irritation. N. Y. Medical Journal, 1868. THE AMERICAN JOURNAL 
OF THfi MEDICAL SCJENCES 
Is the oldest and best-known medical periodical of America, having 
been founded in 1820. It numbers among its contributors the most 
eminent names in the profession, and, according to unquestionable 
authority, "It contains many original papers of the highest value ; 
nearly all the real criticisms and reviews which we possess ; and 
such carefully prepared summaries of the progress of medical 
science and notices of foreign works, that from this file alone, were 
all other publications of the press for the last fifty years destroyed, 
it would be possible to reproduce the great majority of the real 
contributions of the world to medical science during that period." 
Published monthly. $4.00 per annum. 
THE MEDICAL NEWS 
Is the leading medical newspaper of this country. Started in 1843 
as a Monthly, it was changed to a Weekly in 1882. It has been 
shaped to furnish the profession at rapid intervals with the latest 
information on all medical subjects. During the year 1888 THE 
AMERICAN JOURNAL and THE MEDICAL NEWS published 2160 
articles on Progress alone, and, in addition, one and three-quarter 
million words of original matter, the equivalent of 9 octavo 
volumes. THE NEWS *is sent post-paid for $g.oo per annum; 
THE AMERICAN JOURNAL for $4.00, or both at $7.50. 
THE YEAR-BOOK OF TREATMENT FOR 1889 
Now in press for its fifth annual issue, gives a classified statement 
of the value and uses of all remedies which have been introduced 
and practically tested during the year. Price, $1.25; or in com- 
bination with either or both the above journals, 75c. 
THE MEDICAL NEWS VISITING LIST 
Contains 48 pages of indispensable data and 176 blank pages, 
ruled to accommodate all records of practice. Handsomely bound 
in red seal, $1.25. In combination with either or both above 
periodicals, 75c. Or, JOURNAL, NEWS, YEAR-BOOK and VISITING 
LIST, $8.50. 
Lea Brother & (Jo., published, 
1 1 706 & 708 
PHILADELPHIA. -Sansom Street.-