Henry Baird Favill, AB, MD, LL.D., 1860-1916, a ... - University Library

MEDICINE AND PUBLIC HEALTH 153
Printed, Medicine, September, 1901.
CHOREA: ESPECIALLY IN RELATION TO
RHEUMATISM AND ENDOCARDITIS
CHOREA
has been regarded in general as a functional
disease. Whatever was meant by that term, the
basis of that view has been its transient character,
its perversion rather than its destruction of function, and
its lack of morbid anatomy.
No question is more surrounded with contradictions
than that which we must ask at the outset of this discussion:
What is functional disease? Without attempting
to answer, we may reflect upon the various factors that are
concerned in our answer at any given period.
To start with, the designation is relative and subject to
modification as knowledge grows. Hence the conception
has only stability for such periods as afford no advance in
knowledge and classification; in fact, it is always provisional.
It stands primarily in antithesis to the term structural —
organic — and in that relation of course recedes before deeper
acquaintance with pathologic change.
We may readily conceive that in a strict sense there can
be no disease which has not some alteration in molecular
arrangement; hence, which is not finally structural. The
logic of our progressive change of view is to such a conclusion.
Long before such a point is reached, however, we shall
come upon another point of view: To what extent are
structural changes the expression of the exposure of tissue
to altered conditions, probably chemical? and hence are
not such structural changes only partially explanatory of
disease manifestations? And out of this reflection springs
the question: What will a given exposure induce in the
way of symptoms, at various stages of the structural changes