[Hypothesis of the pathology of mediation in surgery (3)]

There are three aspects to mediation: the first of these is purely physiological, or rather is concerned with performance of service functions such as ovulation, sexual activity, sleep, etc.; the second, strictly speaking, may be defined as pathophysiological, as its starting point is considered to be an aggressive event, even when a routine occurrence (in the stomach, for instance, aggression is a constant feature, even when of only slight intensity, as produced by the physical characteristics of the enormous quantities of food transiting the stomach and by particular environmental conditions; the third aspect is distinctly pathological, in that it constitutes the basis for the aggravation of a pathological situation already in progress, sometimes according to the logic of plain addition, but more often according to a more catastrophic process of multiplication (less frequently it takes the form of induction of a prevalent or independent disease condition). This break-down of mediation into distinct types, though necessary from the point of view of academic classification, proves extremely difficult to apply in practice. The validity of this latter consideration obviously depends on the specific area we are tackling. As regards the sex glands and male genital organ, the service role is unquestionable; elsewhere, we can be equally sure that we faced with pathophysiological aspects. In the stomach, for example, the difference between "normality" and "disease" does not lie so much in the absence, as opposed to the presence, of lesions, but rather in their extent and duration. This makes it extremely difficult to draw the line between physiology and pathology, and at the same time suggests that the state of health may be an unstable equilibrium phase somewhere midway between divergent forces belonging to the same mechanism. This latter mechanism may therefore be the key factor both in vital performance and in disease processes, whereas the "classic" aetiological factor may actually be relegated to a secondary role, at least in most cases.