236 NEUROLOGY 



another in ever increasing complexity of organization, and to admit 

 this conception of energies is at once to throw the emphasis of re- 

 search upon the study of functions, and to admit the significance 

 of the anatomical method only as a valued help toward the better 

 understanding of function. 



One unfortunate result of a too close adherence to the anatomical 

 method is that it has introduced into medical literature, and, more 

 important still, into medical thought, a differentiation of disease 

 into two contrasted, although vaguely defined, categories designated 

 as "functional" and "organic," two terms which are objection- 

 able because they help to perpetuate false notions of physiologic, 

 pathologic, and clinical sorts. 1 



However useful these terms may have seemed as affording a 

 convenient, if rough, classification of diseases, and however in- 

 spiring it is to reflect that with the idea of "functional" goes that 

 of possible curability, it is nevertheless true that their employment 

 has had a mischievous because misleading effect, and that it turns 

 away the mind from the true recognition of a nature of the facts 

 at stake. 



Contrast, for example, the cases of hysteria and epilepsy, with 

 regard to which these terms are often used, as if with an essential 

 meaning. If in calling hysteria "functional " and epilepsy "organic " 

 it is meant that the one is curable and the other incurable, neither 

 assumption is strictly accurate. If it is meant that in the case of 

 hysteria there is, presumably, no essential anatomic peculiarity of 

 the brain and nervous system, while in epilepsy such a peculiarity 

 is present, neither assumption is correct. For no one can doubt 

 that the brain of the hysteric is in some degree abnormal, and while 

 we must make the same assumption in the case of epilepsy, we 

 know nothing of the actual change which brings the epileptic fit 

 about or makes it possible, nor can we even say that the fit itself 

 is not a conservative process, in a certain sense. Again, the epilep- 

 tic paroxysm, as such, is a sign which distinctly deserves the name 

 of "functional," as much when occurring spontaneously as when 

 induced by experimental excitation of the cortex. Furthermore, 

 it would be only partially correct, and certainly not scientific, to 

 call hysteria a "functional" and epilepsy an "organic" disease 

 because epilepsy occurs oftener than hysteria in patients who ex- 

 hibit certain physical peculiarities which we classify as stigmas 

 of degeneration. 



It would be equally erroneous to claim that having classified a 

 disorder as "hysterical," and therefore as "functional," we have the 



1 Compare in this connection Obersteiner, Functionelle und Organische Erkran- 

 kungen, 1900; and Krehl, Die Functionelle Erkrankungen, in Die Therapie der 

 Gegenwart, 1902. 



