310 THE CAUSATION OF DISEASE. 



degenerate; if they did not, we should, indeed, have the 

 strongest possible justification for making the distinction 

 between function and nutrition. It is certain that if a 

 muscle remains inactive for some time degeneration ensues, 

 but this may be due to the mechanical effect of muscular 

 contraction on the circulation in the blood-vessels and lym- 

 phatics through the substance of the muscle. 



With these remarks on function, let us proceed to consider 

 the part which abnormality of structure plays in the so-called 

 functional disorders. 



a. Functioned disorders, in which the S remains normal when 

 the nocuous E operates upon it. — I will give two instances of this 

 kind of disorder. A healthy person takes an indigestible meal 

 and suffers from dyspepsia ; or, again, he is poisoned by opium, 

 and in both cases perfect recovery ensues upon removal of 

 the nocuous E. The fact that rapid recovery occurs 

 when the hurtful E is removed — that is to say, after 

 the poison has been eliminated from the body and the indi- 

 gestible matter disposed of — is sufficient proof that these 

 disorders are functional. No one would for a moment contend 

 that there is any gross structural change in either of them. 

 But the question we have now to ask is, does any undiscover- 

 able structural alteration attend these disorders ? An ab- 

 normal E necessarily leads to disordered inter-action of S and 

 E, but does it necessarily lead to an abnormal disposition of 

 the cell particles, or of the cells among themselves ? If it 

 does, this much at least is certain : the change must be a 

 temporary one, for there is rapid return to health after the 

 removal of the nocuous agent. 



If the disorder continues for some time after the complete 

 removal of the nocuous E, we are justified in assuming ab- 

 normality of structure, as I shall presently show ; but in the 

 cases mentioned there is no such continuance of disease-action. 

 And here we are met with the old difficulty — what constitutes 

 normality of cell-structure ? If the structural state of the 

 cerebral cortex which accompanies pain be considered ab- 

 normal, we must obviously predicate a lesion for painful 

 dyspepsia ; and in opium poisoning we are compelled, I think, 

 to conclude that there is an actual deviation from normality 



