PSYCHIATRY IN THE FUNCTIONAL PSYCHOSES 277 



ceived as comparable with the physiological process; the causes of 

 disease being extraneous to normal cell-life are accidental, multiple, 

 discontinuous, without uniformity. It is consistent with this that 

 even in the problem of tumor growths there are some essential 

 explaining facts; whatever of the various theories may be employed 

 to account for them, they are not in dwelling entities, but depend for 

 their existence upon the inherent vitality of the parent organism 

 acting under abnormal conditions. When the organism dies the new 

 growth dies; there can be no disease without prior normal life. 



When applied to functional disorders, the assumption of a neces- 

 sary correlation between a "disease-form" and an underlying struc- 

 tural "disease-process" goes beyond the province of morphological 

 pathology; it involves the intracellular changes of physiological 

 chemistry. It is obstructive of a true conception of the wide varia- 

 tions of function that belong to molecular nutritive and metabolic 

 changes due to variations in condition, irritability, intensity of 

 stimulus, etc., though affecting the same physico-chemical opera- 

 tions by the same agencies. But an authoritative insistence upon 

 the "disease-form" and "disease-process" ideas, with respect to all 

 psychoses, has undoubtedly tended to distract attention from a free 

 consideration of functional conceptions of mental pathology. These 

 and kindred forms of words, with their distinctly morphological 

 stamp, show the character, in some degree, of changing conceptions 

 of pathology. They are kept in use by their convenience; and they 

 appear to be in harmony with certain accepted theories and doc- 

 trines concerning the nature of disease and death, and their relation 

 to life. The influence of these doctrines is so great as to require 

 examination here. 



The difficulty of determining a sharp limit between life and death 

 has been stated by Verworn : l there is no definite time at which life 

 ceases and death begins in a complex organism, for one set of cell- 

 complexes may survive another for a long time; but "there is a 

 gradual passage from normal life to complete death which frequently 

 begins to be noticeable during the course of a disease. Death is 

 developed out of life." "Thus death does not come to the cell 

 immediately, but is the end-result of a long series of processes which 

 begin with an irreparable injury to the normal body, and lead by 

 degrees to a complete cessation of all vital phenomena." It is reasoned 

 that "life and death are only the two end-results of a long series of 

 changes which run their course successively in the organism;" also 

 that "death undergoes a development; normal life upon the one 

 hand and death upon the other are merely the remote end-stages in 

 this development, and are united to one another by an uninterrupted 

 series of intermediate degrees." This transition from life to death is 

 1 Verworn, M., General Physiology, Trans., 1899. 



