The Huxley Lecture on THE NATURE OF DISEASE
Authors: H. Rolleston
Journal: BMJ (1929)

HEALTH1 is tho state (of bodv and(I mind(I rnuisltinig fronii thie successful adaptation of the lilvimmn ogaluisiln to extemnial ailll in-terlnllal factors.Dis-ease (wian1t of ease), NIihicli is a cleparture fmsoni this coichditioni of equilibrium11l 01o at wanit of harmoniy, -hlas heeim ofteni definied, but the definiitionis hiav,e 1not given univrsal satisfaction, mml, as Mercier poimitel ouit, it is miotewortlth that tIle fmmuc(lameiital con- C-epmts oh otlher callin,gs, s hi.-li as time lax, enigimmeering, fiimaimce, .amidxv-ai-, are also limaud tIo cjefilie, amitl tliat this plrociess of s)ecificatiolm, so to spmeak, is mmot ari-rived at unjitil late ill thf ilr llistory,t) houigh their lp)racticall effic'iemi v lhas inot leeni til(-ereby affected.Defiuuitionss arc a ivearlimiess of time tleslm, immmt it max hle ll to cqumote cue oliit of mmlmiy- thlat formuii lated by tlie late J. G. Aclaili iii 1910 as it conltraSts with tb-at of hmealthl aii(l cid ic(-S a (10(1 imiciicatioi of tme potenttial variability in the titiomi e call liscase; it rUmnis as follow s, " Disease is <1 procd(-s5 sUiccessi(mim of clisturh mic-es; jilduce(d(l b)y a :s alelit hmiclm disturbs tile nom-inial activities of tIme (orgammismmm as a wx hole or of its coii- stitueimt I)armts."Jimto ammothem dlelfiitici-that ' disease is a failure of al-liptatioit boflt to c(-mullitiolis Niitlmoctt tile oi-gaiiisimi mi idmtlimi (W. A. Wimite)--may perhmapc be dll two addlitional lpcilnts: filist, t1at tlle mespolmsible cautse sll;V he imisi(le the bodvx (q itt indc Vlw dlleut (of aims- ext'raimeomis factor-for examnimle, so'lue (-zel} litadl striui(tlla!defect *,, a functiomial aberatmill, sticil s time illboinn e'r6oi's of nuetabolismi " or cmlenmica'] immlform-ma tiols " des-rihbed biv Archiba-ld Garrmo(l amjid sec(mix -, that iii tIme process of lillaptatiomi niot omuly may tm-imornmal l esei-v-e powx-er-of time livimug b)odly be c-laledI i1)moi, liut tlhat ill c01-n- paratively sloxi l, (deveiopimig moixo-blid cbimniges, smICehi as valis-ula (lisease of time hiecart ammc lmrrol imIg of caimals stch as the initestine, commipeuatory ois adlaptixe processes secomdla i-v to, bit keeping l)ad-e (ait aims-mate fui-a tinme) xx'itli time Ch ammge, n1a h uimig .}abomtsuchI a ni adjuIst- i1memit thut timer-e is absolumte fi-wdomil fiomn1 sy-mptomns.ThIus dlestrutictioniof one kidimmev miay b)e conipnplssatedl by hy-per- trophlm omf tIme othbe, amilc-'.dstrIuctiimll of a1 pomtiomi of tixe liver b g\' rflueneration in time remaimidelr.S-mptoms, aiid Ilisease in tIme sensse to be explained directly, ; ill olily occur wslieen thmese conipemnsatory mnuisculhar aiid glailudilar hyvper- tr-oplhies fail ; the hitlherto lhitent miorbid cliamige tlmeii gives rise to fiuiietiomial disorder tflat i-, sy-imptonms.This iiiargini of safety " or compensatory-nechlanismn miiust be born-e ii miiind as a difficulty in attaimmiiig the clesir-ed ktiowxledlge fi-oiii time studly, so miiiieli iimsist(l upon by tIme late Jamiles Macliemzie, of time ea-lliest departiures from healtlm foir by the timnie svnmptomns appmear the miiorbid cliam,es mayi be ixell establisimed, anlid the miiaiiifestatioiis miiiglht then be -wrongly regardedi cas fmnctional clhaniges leadinig up to, and esponsible fos, tlme stmi-tctu-al altera- tioIis.Tie n miedlammisms vllic-hs conipemisate or restore damaged tisstes om i]mnlaired funictiom.s,thlough for a vayvimng tinmie emiminenftly sucessful, tenid ee-itumallv to fail amit ttlmeim to hecomee i hlmarnfi; thllls, accom-dlig to Tlmoimia's hmisto-imecluamical colicelptioll (if iterio-sclclosis, tliere is in time fit.stpdlae a local tlickeninig of tile illmic1 coat of thie artery to ol iiate a bimilgimig at a spot wbhieie it ixotild occur as time mesmult of degeneratiomn of thuc musculam-miiddle coat;iii coumi-se of timmie, unix-ever, tlse thickened ar ea ini the imitimiia a Isu dlegenlerates, aid -lat w-as ai conipemisatorv pSlocess be(omm)es a1 mnim-bid lesiomi.Furthei-, time compenlsa- toss and delfenfsive poiwers oL tlme bodv miav fim-eo time oumtset be ineffectixe for exanpl)he, wlmeix immflammation, cdefimmed as