WHAT IS A DISEASE? 233 



diseases and regard them as diseases ? How do we contemplate 

 them and estimate them ? That is the problem that we are 

 to solve. 



Before we can attack this problem with success, we must 

 settle certain preliminaries and clear up certain obscurities ; 

 and it will assist us in our task if we show that certain things 

 sometimes called diseases are not diseases. 



In the first place, let us note that we always regard a 

 disease as an individual thing. It may include many symp- 

 toms, and it may include other things that are not symptoms, 

 for instance, it may include structural change and damage in 

 internal organs ; but these are parts or factors that go to make 

 up the disease, and what we mean by a disease is always an 

 individual thing or whole. We speak of treating the disease; 

 we speak of the disease being fatal ; we speak of fluctuation 

 of the disease : we speak of the disease becoming more severe, 

 or less severe : we speak of its beginning and its ending ; and 

 in each case the phraseology shows that we regard the disease 

 as an individual thing. The use of the article alone is conclu- 

 sive of this. 



It is unnecessary to show that a symptom is not a disease, 

 is not at any rate necessarily a disease, for this is the thesis 

 with which we started ; but it may be advisable to show that 

 structural disease, deteriorating change of structure, or struc- 

 tural damage, is not a disease. It is advisable to show this 

 because we often speak as if structural damage of an organ 

 were a disease. If we ask what disease a patient is suffering 

 from, and are told that it is inflammation of the lung, or ulcer 

 of the stomach, or cancer of the liver, we accept the answer 

 as satisfactory, and are not struck by any incongruity between 

 the answer and the question. But this is because we do not 

 take the answer in its literal sense. We do not understand it 

 to mean the structural damage alone. An inflamed lung, an 

 ulcerated stomach, or a cancerous liver may exist in a dead 

 body ; may be taken out of the body and preserved in spirits ; 

 and it will be acknowledged that it would be erroneous and 

 absurd to call the preserved organ a disease. It is a diseased 

 organ, but it is not a disease ; and if it is not a disease when 

 taken out of the body, neither is it a disease when it is in the 

 body. If it is not a disease after death, neither is it a disease 

 during life. Yet we speak of ulcer of the stomach as a disease. 



