234 SCIENCE PROGRESS 



But when we speak of ulcer of the stomach or any other 

 structural change as a disease, we do not mean what we say. 

 We express ourselves inaccurately. The expression is approxi- 

 mate only, as so many of our expressions are. We do not 

 regard a patient who suffers from ulcer of the stomach merely 

 as a person in whose stomach there is an ulcer, and there 

 end our contemplation of him. We think of him as a person 

 who not only has an ulcer in his stomach, but also suffers the 

 consequences and presents the symptoms of ulcer of the 

 stomach ; and it is these additions to the bare structural 

 change that constitute, with that change, the disease from 

 which the patient suffers. There are, in fact, two very 

 different concepts connoted by the names of most damaging 

 changes of structure. The name may mean the structural 

 damage, the ulcer in the stomach, the lumps of cancer in the 

 liver, the consolidation of the lung, and nothing more ; and 

 then it is a term in morbid anatomy. It means disease of an 

 organ, or it means a diseased organ ; but it does not mean a 

 disease. The name may, however, be employed with the 

 connotation, not only of the structural damage, but also of 

 the consequences, accompaniments, and symptoms of that 

 damage when it exists in the living body, and, so employed, 

 the name of the structural damage does stand, or may stand, 

 for the name of a disease. 



It may stand for the name of a disease, but even when it 

 carries the connotation of its consequences and symptoms, 

 the name of a structural damage does not always stand for a 

 disease, at least for the whole of a disease. In the course of 

 acute rheumatism a valve of the heart may suffer structural 

 damage, and this structural damage has its own group of 

 consequences and symptoms. It allows of regurgitation of 

 the blood into the cavity it has just left, it gives rise to a mur- 

 mur, it causes shortness of breath, cyanosis, oedema, and so 

 forth, all of which are summed up and included in the term 

 ' heart disease ' ; yet this structural damage to the heart, 

 associated though it is in our minds with its consequences and 

 symptoms under the name of heart disease, does not consti- 

 tute ' the disease ' from which the patient suffers. The 

 group of structural damage, consequences, and symptoms is 

 an important part of the disease, no doubt, but a part only ; 

 for ' the disease ' is acute rheumatism. Again, from the 



