Are we justified in using the term functional? If by it we are to understand that abnormal action can occur with normal structure and normal influences from without, I should say no. There must be some reason for the wrong doing. If it is not in surrounding circumstances and influences, we might look to the organ itself. "There are, no doubt, disorders of which we do not know, and perhaps never can know, the essential cause-whether intrinsic or extrinsic, or, if intrinsic, of what nsture. But the mills of God grind exceeding small, and there is much in nature, sound or sickly, which is not to be reached by the coarse vision and clumsy methods of the present century."

How little do we really know of normal structure. Who can understand the nature of protoplasm? Who has determined the action of stimulus upon nervous matter? What is the ultimate nature of those substances upon which life process seems to depend-the fermentsand whence their origin? Who can explain the power of cellular reproduction, etc.? We do not know the exact nature of a single organic cell. If, then, our knowledge of normal structure be so meager, how very imperfect it must be of those subtle pathological conditions which form the physical basis of disease.

Nowhere in the realm of medicine is pathology so obscure as in the nervous system. This is one reason why study of nervous diseases is so difficult. How very natural for us to select the easiest way out of our embarrassment and say the disease is functional, thereby clothing our ignorance in the stately robes of high-sounding phrases.

When we stop to consider seriously the nature of the so-called functional diseases of the nervous system, we readily discover the fallacy of our reasoning. Can you imagine a nervous system so malevolent that, with a normal structure and with normal influences, it will persist in producing those irregular, involuntary, inco-ordinate muscular contractions, with loss of consciousness, and often attend bodily injury, which we call the epileptic fit, and that it will persist in its nefarious habit until its victim becomes the inmate of a madman's cell! And yet to-day we find it classed as a functional disease. Or, again, will you say that in chorea it is the unreasonable and unaccountable caprice of a normal structure that causes the skin to be eroded, the muscles to waste, the faculties to fail, and the patient to die?

And once more, in that protean malady, hysteria, is it a normal structure which, under normal influences, produces the manifold symp toms of this disease and makes the patient an abject slave to its unreasonable demands? By no means. If a machine does not work properly we look to its parts. When we see an effect we know there is a cause. If that cause be not in external influences it must be in structural change. Organic changes are not of necessity obvious. They may elude our modern methods and vigilance. They are none the less real or potent by so doing. Changes of a nutritional nature, undiscoverable

and insignificant as compared with the grosser lesions, may nevertheless be colossal in character when compared with the molecular structure of the cell. The girl in "Midshipman Easy" could not excuse the illegitimacy of her child by saying it was a wee little one, nor can we ignore these nutritional changes because of their apparent insignificance.

Normal action presupposes normal structure and normal influence; abnormal action presupposes abnormal structure or influence. The animal cell is capable of varied activities, and when these activities are within physiological limits we have a condition of health. When they overstep the boundaries set by nature we have disease. Where physiology ends pathology begins.

How, then, shall we regard the term.

DISCUSSION.

DR. O'Connor: I enjoyed the Doctor's paper very much. I think it more of a literary effort than a scientific paper.

DR. MOREN (visitor): The word "functional" covers much of our ignorance. I have just noticed in a new text-book a suggestion that we change the term functional to neuron disease. In these functional troubles we are unable to find the pathological changes. In organic conditions we can.

Society Proceedings.

PROCEEDINGS OF THE LOUISVILLE MEDICAL AND SURGICAL SOCIETY, OCT. 18, 1905.

DR. POPE: I reported to this Society on two occasions previously a case of exophthalmic goitre in a woman with a pulse of 168, very much emaciated, the thyroid gland markedly enlarged and the eyes protuberant. The lady weighed 1154 pounds when she entered The Sanatorium and left weighing 158 pounds, after a period of three and a half month's treatment. The pulse dropped to what I considered to be normal, 84. There were no evidences of any goitre or protuberence of the eyes. She left the infirmary the latter part of July or the first of August, and I had a letter day before yesterday from her physician stating that she was entirely well and that her pulse was 72. This taken in conjunction with the serious character of the case speaks very highly of the treatment outlined at that time. This consisted of hydrotherapy, the application of an ice bag to the heart, massage, vibration and the employment of hygienic and dietetic measures.

Of the other two cases that I wish to report to-night, the first is that of a clergyman of the Catholic Church sent to me from Indiana by a friend of mine, and the case is reported as being to me most interesting. This patient has been a close student and is an intellectual and charming gentleman. He is the most enjoyable person that I have been thrown with in some time, although I only saw him for three days. He has been a sufferer from chronic headache for fifteen years, and has run the gamut of all the ocular experiences from eye glasses and mydriatics to muscular tenotomies and what not. He has tried first one thing and then another until to be very frank with you he was a first-class doctor on his own case. He had read considerably about it and had gathered an immense amount of data.

The case was one that presented absolutely no evidences of any gastric or intestinal involvement. I could find no enteroptosis that we frequently find in these cases, no nephroptosis or anything in the physical examination that would likely have produced the headaches. But upon examining the contents of the stomach we found this man to be suffering from a very high degree of hyperchlohydria; in fact, it was considerable; the ordinary amount in the metric system being 180, in his case it was 280. The hydrochloric acid which normally in the metric system is .025, in his case was 142. This condition was treated only for two days and then he was given hygienic and dietetic instructions together with medicinal treatment to overcome the trouble. For the first time in fifteen years he has gone two months without the semblance of a headache.

The second case is that of a lady who was taking forty-six grains of morphine a day, and taking the forty-six grains in four hypodermic doses. In all my experience with morphine habitues, that is a pretty lively dosage, being nearly twelve grains at each hypodermic dose. She was under my care from July 22nd until about the middle of September. She made an uninterrupted recovery and is now entirely well and entirely. free from the drug. Among the interesting features of the case was that of the slow pulse. I have rarely seen these cases with a slow pulse. Her pulse was 60; she weighed 120 pounds when she entered the infirmary, and when she left her pulse was 88 and she weighed 144 pounds.

The blood condition was very low, the hemoglobin only registering 40, with marked leucocytosis and a great many microcytes. Those of you who have attempted to follow the clinical work that has been done along the examination of a fresh specimen of the blood would be surprised to find how many microcytes we find where the case is one of extreme mal-nutrition, and particularly so when brought about by a nervous influence, as in morphinism and those affections that involve the central nervous system. This woman had a marked diminution in the elimination of the solid constituents of the urine; in fact, they were diminished nearly 50 per cent. In addition, she was suffering from a great deal of pelvic trouble, which she claimed was the origin of morphinism, although

the symptoms had been entirely masked by the dosage of forty-six grains a day. The cervical canal was the smallest that I had ever seen in my life, and this was dilated until it carried a 26 French sound with considerable benefit to the patient. The woman had two periods while in the infirmary without any trouble. In addition to the general treatment employed for the morphinism, she was given intrauterine treatment by electricity.

DR. S. P. MYER: How long had she been using forty-six grains a day?

DR. POPE: She had been using forty-six grains a day for four years. She had used morphine in smaller doses continuously for fifteen years.

DR. GUEST: I was much interested in that morphine case. Being City Physician for the past eight years I have seen a great many cases of morphinism. We have probably 200 cases a year at the work-house; that would make 1,600 cases, and I have seen forty or fifty cases in private practice. The largest dose that I remember that any of those took was seven grains at a dose. This was taken only twice a day, morning and night. Another case I remember that was successfully treated in private practice was a prominent physician who took twenty-seven grains a day in four or five doses. I was struck with the unusually large dose that the doctor's patient was taking.

DR. SIDNEY J. MEYERS: I would like to ask Dr. Guest whether the morphine is entirely withdrawn from the prisoners at the work-house? DR. GUEST: Absolutely.

DR. REESOR: What treatment is given after they are taken off?
DR. GUEST: Stimulation.

DR. HENDON: I would like to ask Dr. Pope how he cured the case? DR. POPE: I thought the Doctor had gotten a copy of my pamphlet on morphinism. My plan is to as rapidly as is consistant with the physical state of the patient reduce the dose to a certain point and then put the patient to bed and give him the full Weir-Mitchell treatment. He is put in a room with a nurse and the morphine withdrawn in a day or two. I stimulate with strophanthus and strychnine.

I would like to say to Dr. Guest that my experience is that the average dose runs from eight to fifteen grains per diem. This summer I have had a remarkable run with doctors. One took sixty-five grains per diem. He was under the impression that he was taking twenty-five grains, and the capsules were weighed and found to contain sixty-five grains. He never had any disagreeable symptoms in the progress of withdrawal. It may be interesting to state that the morphine habitue will oftentimes tell you if you will give him a full treatment by the incandescent electric light bath that the dose of morphine may be left off.

I have gone into the subject in my article, and I will take pleasure in mailing Dr. Hendon and the other gentlemen who may wish one a copy. It was read before the Mississippi Valley Association, at Cincinnati, in

1904, and has been copied in the Quarterly Journal of Inebriety, and one or two other journals in this country and in the Journal of Inebriety of London.

DR. POPE: This is rather a meager amount of information upon which to give an opinion, but from what the doctor stated in his description if we had had an infection previously I would have thought that he had to deal with an inflammatory condition in the gray matter of the spinal cord. It seems to me it would be a very curious diagnosis to make of multiple sclerosis based upon the symptoms the doctor detailed here. It seems to me that the diagnosis rested between an inflammatory trouble of the gray matter of the brain and spinal cord or possibly some of those functional or toxic mental conditions that arise from changes in metabolism or the absorption of toxines or posions from the gastro-intestinal tract or the retention of uremic poisons in the system, but it is a curious thing to find a complete incontinence of urine and feces in these cases. It is suspicious of, to say the least, a mild grade of myelitic trouble.

DR. SIDNEY J. MEYERS: Speaking along that line, I was called to see a man suffering from ataxia with a sudden development of a mental condition, and he had slight symptoms, except that while he did not pick up paper he was continually trying to pull the sheet on for his underdrawers. He would try for an hour at a time to put the sheet on for his drawers.

I was called at 12 o'clock at night, and it took two policemen and two neighbors to take that man to an institution. He fought all the way. When we got to the institution Dr. Burnett, who is a small man, told him to come in, that he wanted to give him a hypodermic, and he went with him quietly. It shows the influence of surroundings upon these patients.

ators.

DR. ABELL: The essayist has given us a very thorough and fair presentation of the subject. He has given us the views of the various operWe find that they differ quite markedly, one side preferring one route to the exclusion of the other, while the opposite side prefers the opposite route. I think he has been very fair in his discussion of the cases which indicate a preference for the supra-pubic. He has given the advantages and the disadvantages of each-the disadvantages of the perineal route particularly in the cases of high location of the prostate and the disadvantages that follow afterwards in the shape of incontinence. The ejacualtory disturbances can very appropriately be excluded from these cases. I had two cases, in one of which there was almost a total loss of the ability to perform the sexual act, which in the course of a year and a half after the operation completely returned. He was operated on two years ago and he says that his ability is more marked than before the operation.

There is one point about the Goodfellow operation. I think we must surely remove the ejaculatory ducts. I have seen the occurrence of epi