276 PSYCHIATRY 



More remarkable examples of doubtful usage, universal in medical 

 literature, and with far-reaching effects, are shown in the words 

 "disease-form," "disease-entity," "disease-process," and "patho- 

 logical process," which have already been mentioned. These words 

 still suggest old meanings now wholly obsolete; this is so obvious 

 that when thoughtful writers use such words "for convenience," the 

 explanation is not infrequently made that it is not intended to imply 

 that disease is a malign entity which invades the living body and 

 works its evil course. Yet, as usage sanctions it, writers continue to 

 employ the framework of words which would once have expressed the 

 ancient parasitic personification of disease. While, in the science of 

 pathology, this extreme conception is corrected by explanation, such 

 words in their modern usage still embody and positively convey the 

 sense of an underlying morphological counterpart of the symptom- 

 complex that runs its course of progressive degeneration as a disease 

 and reveals the terminal changes in post-mortem findings. To speak 

 of all disease in terms used in these senses is to emphasize structural 

 conceptions of pathology, and thus to impede the progress of the 

 reform which is clearly seeking to give adequate attention to func- 

 tional conceptions in place of the dominating demand for mature 

 types and forms and classifications. 



It would be interesting to follow out the history of the usage of 

 these verbal embodiments of whole theories. Perhaps a reference to 

 main points will be enough to indicate the purport of these observa- 

 tions. First, as to the nature of disease, it cannot be correctly con- 

 ceived as a state of disordered activity or disorder of a process in an 

 active sense; there is a condition produced by a defensive contest 

 bet ween the forces of the living cell and the harmful agencies; it is not 

 a state of perturbed activity but the result of it in diseased organs 

 or tissues. The causes of disease are extraneous and unnecessary to 

 cell-life, which can exist without disease. The only true process in 

 living organisms is the physiological, or life-process; the forces that 

 cause the reactions called vital phenomena are inherent and are 

 governed by the uniform laws of an invariable order of nature; like 

 effects result from like causes and conditions, and the life-process 

 presents the attributes of uniformity and continuity controlled by 

 the laws of descent. Reproduction is an original property of living 

 matter and life is continuous, and death is not due to such a prop- 

 erty; this is a proposition in which there would be a general agree- 

 ment with Weissmann. Roger 1 reduces the conception of death to 

 the formula: "Death is the result of an arrest of cellular nutrition; 

 whatever the multiple proceedings are that are called into play, the 

 final result is always the same." 



A "disease-process" or "pathological process" cannot be con- 

 1 Roger, G. H., Introduction to the Study of Medicine, Trans., 1901. 



