284 PSYCHIATRY 



is without external manifestations of energy; but that the func- 

 tion of work, which is the power to store potential energy within 

 and to produce kinetic energy in external work, belongs to the 

 highly specialized cell as an acquired character which it may lose. 

 This being true we may understand that assimilation and dissim- 

 ilation, in the limited sense employed by Hering, constitute a 

 special kind of inclusive metabolic process different from the mole- 

 cular changes, perhaps less complex, productive only of growth. 

 It is not conclusive that katabolism typically represents destruc- 

 tion of life, though it means changes of substance in which life 

 exists. These considerations suggest questions that are not in 

 harmony with the generally accepted theory of life and death as 

 concomitant processes based upon an assumed analogy to the 

 physiological processes of the healthy living cell. 



This inquiry is intended only to consider some examples of cur- 

 rent theories with the question whether they can be resolved into 

 more simple conceptions. The life-process being conceived as the 

 one supreme "process" in living organisms, this implies its main- 

 tenance by causative forces; assuming each individual to. be 

 endowed with a given vital durability, determined by antecedent 

 conditions and subject to modifications due to favoring or adverse 

 influences, the life-process reaches its possible attainments and 

 finally fails in the struggle for existence. Injury, interference with 

 normal function, overuse and disuse, disease, and the causes of 

 the changes of senility present alike adverse influences which the 

 organism fails to overcome. We must speak of disease and use 

 its meaning as referring to results in diseased parts, organs, or 

 tissues; and we may commonly think of the word as implying a 

 combination of disorders of functional activities which may or may 

 not be associated with ascertainable structural changes. But it 

 should be remembered that we are thinking of a patient and not 

 a "disease." There is no disease-process; no causative forces exist 

 in nature that induce and carry on processes of degeneration and 

 decay; gradual failure is the summation of the failures of com- 

 munity work due to the complexity of the organism, each organ 

 being subject to the harmful influences of the functional failure 

 of other members of the community. There may be deterioration 

 of function, and degeneration of structure in the sense of failure 

 to maintain it; there may be also regressions or rather recessions 

 of results, but no active pathological "process" of going backward 

 in the structural reductions called "degenerative." These consid- 

 erations do not support the idea of a "physiological old age," based 

 upon the conception of a normal process of degeneration or decay 

 as though the results of senile conditions in structural changes are 

 different from disease. This doctrine of natural decay and death 



