THE CAUSATION OF DISEASE. 34 1 



affections of the spinal cord. In most text-books these are 

 classified with great care and precision, and the student sets 

 himself to learn them diligently. But what does he find when 

 he comes to observe for himself? That he very rarely meets 

 with the disease exactly as described in the book. He soon learns 

 that, with few exceptions, he must consider each case on its 

 own merits, and that that physician makes the best diagnosis 

 who can specify the particular parts of the cord that are diseased 

 and the nature of the pathological process, and who is content 

 to rest there, without necessarily pigeon-holing the disease into 

 any special department, and racking his brain to make the case 

 accord with some particular classical type. 



These remarks apply with double force to mental disorders. 

 It is truly pitiable to examine into the ponderous literature of 

 those most wonderful of all diseases — diseases of the mind — and 

 to contemplate this craving for classification. Of all diseases, 

 mental diseases are the most subtle, and of all, perhaps, the most 

 variable ; but the author, in his desire to classify, is painfully 

 anxious to set rigid limits even to them ; and so it is with all. 

 Every man, when he leaves hospital, and has to deal with 

 diseases on his own responsibility, must be struck with the 

 vast difference between disease as he has learnt it from the 

 books and as he actually finds it. For some time he endeavours 

 to name every case, but, if he is a thoughtful man, he soon 

 discovers the futility of this ; he learns to consider every disease 

 on its own merits, and thus, while he makes full use of classi- 

 fications and types, he is ever prepared to meet with cases which 

 stand alone, which never have " been"' before, and perhaps never 

 will "be" again. 



These considerations it was that led me, when speaking of 

 terminology, to say that " it matters little by what word, or com- 

 bination of words, we choose to designate any particular disorder, 

 so long as we have a clear idea of the morbid inter-actions (or 

 what is known of them) which the name chosen is intended to 

 connote ; and inasmuch as the morbid inter-actions are in no 

 two cases even of the so-called ' same ' disease, exactly alike, 

 we must allow a considerable latitude to the meaning of any 

 term, modifying it in different cases according to our exact 

 knowledge of the morbid process." 



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