Licence: Public Domain Mark
Credit: A system of medicine / edited by J. Russell Reynolds. Source: Wellcome Collection.
Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.
24/974 (page 6)
![one class of powers, the muscular cell another class, and the secreting organs a third. 3d. A third class of facts to be remembered is, that in many diseases, the only symptoms to be recognised are changes in the degree of activity with which certain organs perform their functions. No new element is introduced by some diseases into the category of vital actions ; such affections as chorea, hysteria, epilepsy, might be shown to consist of mere modifications in the degree, time of occurrence, and combinations of functions, each of which, taken ])er se, is consistent with health. The sudden loss of consciousness in epilepsy, for example, is not more mysterious than is the sudden, but every-day recurring passage from wakefulness to sleep; the arrested respiration is similar in kind to that seen when the chest is fixed in the performance of any great muscular exertion involving the upper limbs ; and still more similar to that which can scarcely be called morbid, the prolonged apnoea of a screaming child, whether the scream be the expression of terror, temper, or pain; the convulsive move- ments are neither more nor less than nerve and muscular functions, any of which might separately, and many of which might, in combi- nation, be the expression of healthy vital activity. Trom these three classes of facts, therefore, we are compelled to admit that, in the present state of science, the onus probandi lies with those who assert the constant presence of structural in association with functional change ; and we affirm that those who make the assertion have never proved their point. Further, that as a matter of inference from what we know of the relation subsisting between structure and function in health, we should not even expect to find solutions of continuity or coarse changes of texture in those diseases, the essential elements of which are functions altered, not in kind, but only in degree and mode of association; and that, on the other hand, when we do find material changes in association with functional disturbances we should refer many of the latter only indirectly to what we see of the former, the more numerous and more important of them being dependent upon what we do not see, viz. the finer changes in the interstitial processes of nutrition. A scirrhous tumour of the stomach, for example, may produce certain symptoms easily explicable by its mechanical effects ; it may be so situated as to prevent the ingress or egress of food ; but vomiting may occur when the orifices are free, or when the tumour is situated in some organ in the pel vis : the supposed tumour may cut off the supply of food, and so explain some of the changes we see in colour and general nutrition; but, on the other hand, the extreme of wasting and of cancerous tinting may be seen when there is no such enforced abstinence from food, but when indeed a large quantity is not only taken, but is digested and enjoyed. So again a clot of blood in the corpus striatum may sever the nerve-fibres, and so explain the severance between the will and certain muscles of the extremities; but it will not so explain the presence of convulsions, or of spasms in those palsied limbs. For these reasons we retain the words functional disease; under-](https://iiif.wellcomecollection.org/image/b2198010x_0001_0024.jp2/full/800%2C/0/default.jpg)
